Excerpt from Granuloma, Annulare and Pyogenic

Synonyms, Key Words, and Related Terms: GA, dermatosis, pyogenic granuloma, PG, vascular tumor of skin and mucous membrane, papule, nodule, peduncle, granuloma annulare, subcutaneous GA, self-limited dermatosis, disorder of angiogenesis, skin nodule, sclerosis, lymphedema, joint ankylosis, necrobiosis lipoidica diabeticorum, rheumatoid nodules, benign vascular tumor

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Background: Granuloma annulare (GA) is a benign self-limited dermatosis characterized by a raised annular configuration.

Pyogenic granuloma (PG) is misnamed, being neither pyogenic nor granuloma. It is a benign, acquired, vascular tumor of the skin and mucous membrane that appears as a rapidly growing vascular papule or nodule. Sometimes it appears at the site of a previous penetrating injury. PG is often observed in infancy and childhood but also may be observed in adults, particularly in pregnant women.

Pathophysiology: GA may be localized, generalized, perforating, or subcutaneous. Lesions of the first 3 presentations have similar appearances, but each one follows a distinctive clinical course. Subcutaneous GA appears differently, as it is a disease of childhood in which deep dermal or subcutaneous nodules lie on or near the periosteum and are distributed on the feet, lower legs, fingers, hands, forearms, scalp, and forehead.

PG is a disorder of angiogenesis whose underlying etiology remains unknown. A predilection exists for the head and neck, although lesions may appear on any part of the body. Purplish, pulpy, vascular lesions of PG often involve the gum and other mucous membranes of the mouth.

Frequency:

In the US: GA is most common in children and young adults. Solitary PG is common and represents 0.5% of all skin nodules in children.

Mortality/Morbidity:

GA is a self-limited cosmetic disease without any systemic medical complications. On rare occasions, it may involve fascia and tendons and may cause sclerosis, lymphedema, and deformities such as joint ankylosis. GA has been epidemiologically linked to diabetes mellitus, necrobiosis lipoidica diabeticorum, and rheumatoid nodules.

PG is a benign vascular tumor, mostly occurring in childhood. Lesions may bleed and ulcerate.

Race:

GA is believed to affect patients without respect to racial heritage.

PG may affect white populations more than other racial groups, but this is not well proven and the observation may reflect sampling bias.

Sex: GA has a slight tendency toward females.

In GA, females are slightly more affected than males.

In PG, the male-to-female ratio is 3:2.

Age:

More than two thirds of patients with GA experience disease onset when younger than 30 years. In pediatric patients with GA, the age of onset ranges from 1-14 years, with a mean of 4 years. The localized type of GA occurs primarily in young children, whereas the generalized form is seen in patients younger than 10 years or older than 40 years.

Approximately one half of cases of PG occur within the first 5 years of life.