Case for Diagnosis
Beaded Nodules on the Forearms
Nódulos «arrosariados» en antebrazos
I. García Río
, S. Heras Gonzalez, M.I. Martínez Gonzalez
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Servicio de Dermatología, Hospital Universitario de Araba, Vitoria-Gasteiz, Álava, Spain
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García Río, S. Heras Gonzalez, M.I. Martínez Gonzalez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "García Río" "email" => array:1 [ 0 => "Irene@aedv.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Heras Gonzalez" ] 2 => array:2 [ "nombre" => "M.I." "apellidos" => "Martínez Gonzalez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Araba, Vitoria-Gasteiz, Álava, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulos «arrosariados» en antebrazos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 401 "Ancho" => 207 "Tamanyo" => 8963 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">An 83-year-old woman with a history of hypothyroidism and depression, which was being treated, was referred to our department by the rheumatology department, where she was in follow-up for osteoporosis. She reported the gradual appearance of asymptomatic nodules on the forearms; the nodules had appeared a year earlier and were not associated with prior trauma or any other trigger.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient presented between 8 and 10 subcutaneous nodules in the cubital region of both forearms; the nodules measured between 0.5 and 1.5<span class="elsevierStyleHsp" style=""></span>cm in diameter, were of a rubbery consistency, skin-colored, with a smooth surface, rounded, and arrayed in a line (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient presented joint deformities of the metacarpophalangeal joints with no signs of arthritis, and no other skin lesions were observed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Involvement of the entire thickness of the dermis was observed, with foci of partial collagen degeneration, surrounded by a discrete lymphohistiocytic infiltrate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Tests revealed elevated PCR (30.7<span class="elsevierStyleHsp" style=""></span>mg/L); ANA (+) at a 1/320 titer, and anti-ENA (+); SS-A, 68<span class="elsevierStyleHsp" style=""></span>U/mL. Other parameters (hemogram, biochemistry, erythrocyte sedimentation rate, rheumatoid factor, anti-CCP2, urinary sediment, proteinogram, immunoglobulins, C3, C4, anticardiolipin antibodies) were normal or negative. X-ray of the hands, forearms, and spine showed signs of degeneration and reduced bone density.</p></span><span id="sec1025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1025">What Is Your Diagnosis?</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Subcutaneous granuloma annulare.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Because of the pain reported by the patient, after a 1-year follow-up period, treatment with 2 intralesional injections of triamcinolone in suspension at a concentration of 1:2 was instated, followed by oral vitamin E (200<span class="elsevierStyleHsp" style=""></span>mg/d) for 6 months. The condition resolved completely and no relapse was observed in the last 10 months of follow-up (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Granuloma annulare (GA) is a benign form of dermatosis of uncertain origin and is generally self-limiting; it may present different clinical forms, the most common of which are localized, generalized, subcutaneous, and perforating GA.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Several rare or atypical patterns of GA exist, including follicular GA, macular GA, patch GA, and linear GA.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> Subcutaneous granuloma annulare (SGA) is a rare variant of GA and is more frequent in children. It is characterized by the appearance of asymptomatic unadhered nodules of variable size and a firm elastic consistency, with normal overlying skin.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> The most frequent locations are the head, lower extremities, forearms, and backs of the hands and feet.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> Diagnosis is clinical and histologic, and the disease presents a broad differential diagnosis that includes abscesses, calcified hematomas, soft-tissue tumors, fat necrosis, reaction to foreign bodies, and interstitial granulomatous dermatitis. Histopathologic differentiation, however, should principally include rheumatoid nodules (RN).<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> Differentiation may be difficult, as both diseases present a granulomatous dermal infiltrate consisting of an area of collagen necrobiosis surrounded by palisading histiocytes.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> RN present better circumscribed abnormal connective tissue located more deeply and fibrin deposition in the collagen is highly characteristic.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> RN tend to have giant cells in the palisade of histiocytes, but the key histiologic finding for differentiating the diseases is the presence of mucin in the area of necrobiosis in SGA.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> In our patient, we identified mucin deposits using colloidal iron and Alcian blue, which together with negative results for RF and anti-CCP2 and the absence of clinical findings of rheumatologic disease, aided us to perform the differential diagnosis between the 2 processes. With respect to treatment, many drugs have been proposed with variable results; the most accepted approach is not to treat.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> In our case, we decided to treat, with an excellent response; nevertheless, the possibility that remission was spontaneous cannot be ruled out. Few cases of SGA or linear GA have been reported and we have found no cases similar to ours. We would like to highlight the exceptional nature of the clinical presentation, in the form of linear beaded nodules, which has not been described to date. While this is an atypical presentation, the potential diagnosis of SGA should be taken into account to avoid unnecessary treatment.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:3 [ "identificador" => "sec1025" "titulo" => "What Is Your Diagnosis?" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] ] ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García Río I, Heras Gonzalez S, Martínez Gonzalez MI. Beaded Nodules on the Forearms. Actas Dermosifiliogr. 2019;110:597–598.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 277 "Ancho" => 501 "Tamanyo" => 17993 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 667 "Ancho" => 905 "Tamanyo" => 142631 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin–eosin ×1.3. B, Hematoxylin–eosin ×2.6.</p>" ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 401 "Ancho" => 207 "Tamanyo" => 8963 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma annulare: Clinical and histologic variants, epidemiology and genetics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.W. Piette" 1 => "M. Rosenbach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2015.03.054" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2016" "volumen" => "75" "paginaInicial" => "457" "paginaFinal" => "465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27543209" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma anular lineal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. López-Obregón" 1 => "A. Mª López-Núñez" 2 => "A. López-Pestaña" 3 => "C. Tuneu" 4 => "P. Lobo" 5 => "Eguino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Cutan Iber Lat Am" "fecha" => "2010" "volumen" => "38" "paginaInicial" => "244" "paginaFinal" => "247" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asymptomatic papulo-nodules localized to one finger" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.D. Rambhia" 1 => "U.S. Khopkar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5154.164441" "Revista" => array:7 [ "tituloSerie" => "Indian J Dermatol" "fecha" => "2015" "volumen" => "60" "paginaInicial" => "522" "paginaFinal" => "525" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26538733" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022395610002165" "estado" => "S300" "issn" => "00223956" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subcutaneous granuloma annulare" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Requena" 1 => "M.T. Fernández-Figueras" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.sder.2007.02.006" "Revista" => array:6 [ "tituloSerie" => "Semin Cutan Med Surg" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "96" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17544961" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Nodulosis reumatoidea o granuloma anular profundo?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Revenga Arranz" 1 => "P. Sanz Moncasi" 2 => "J. Paricio Rubio" 3 => "J. Medina Luezas" 4 => "P. Ruiz Martinez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "1999" "volumen" => "90" "paginaInicial" => "124" "paginaFinal" => "127" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000007/v1_201909021030/S1578219019300587/v1_201909021030/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011000000007/v1_201909021030/S1578219019300587/v1_201909021030/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019300587?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 8 | 18 |
| 2024 Octubre | 82 | 42 | 124 |
| 2024 Septiembre | 86 | 29 | 115 |
| 2024 Agosto | 116 | 48 | 164 |
| 2024 Julio | 115 | 39 | 154 |
| 2024 Junio | 78 | 28 | 106 |
| 2024 Mayo | 102 | 39 | 141 |
| 2024 Abril | 78 | 17 | 95 |
| 2024 Marzo | 86 | 24 | 110 |
| 2024 Febrero | 76 | 45 | 121 |
| 2024 Enero | 105 | 33 | 138 |
| 2023 Diciembre | 81 | 17 | 98 |
| 2023 Noviembre | 89 | 32 | 121 |
| 2023 Octubre | 71 | 23 | 94 |
| 2023 Septiembre | 69 | 31 | 100 |
| 2023 Agosto | 49 | 14 | 63 |
| 2023 Julio | 74 | 29 | 103 |
| 2023 Junio | 61 | 26 | 87 |
| 2023 Mayo | 81 | 21 | 102 |
| 2023 Abril | 101 | 14 | 115 |
| 2023 Marzo | 122 | 22 | 144 |
| 2023 Febrero | 74 | 19 | 93 |
| 2023 Enero | 32 | 20 | 52 |
| 2022 Diciembre | 60 | 37 | 97 |
| 2022 Noviembre | 44 | 25 | 69 |
| 2022 Octubre | 39 | 17 | 56 |
| 2022 Septiembre | 58 | 36 | 94 |
| 2022 Agosto | 74 | 33 | 107 |
| 2022 Julio | 68 | 36 | 104 |
| 2022 Junio | 31 | 32 | 63 |
| 2022 Mayo | 77 | 36 | 113 |
| 2022 Abril | 82 | 26 | 108 |
| 2022 Marzo | 85 | 57 | 142 |
| 2022 Febrero | 77 | 24 | 101 |
| 2022 Enero | 105 | 33 | 138 |
| 2021 Diciembre | 84 | 37 | 121 |
| 2021 Noviembre | 69 | 42 | 111 |
| 2021 Octubre | 66 | 45 | 111 |
| 2021 Septiembre | 56 | 31 | 87 |
| 2021 Agosto | 58 | 31 | 89 |
| 2021 Julio | 48 | 20 | 68 |
| 2021 Junio | 41 | 18 | 59 |
| 2021 Mayo | 50 | 33 | 83 |
| 2021 Abril | 99 | 45 | 144 |
| 2021 Marzo | 70 | 20 | 90 |
| 2021 Febrero | 52 | 19 | 71 |
| 2021 Enero | 36 | 10 | 46 |
| 2020 Diciembre | 33 | 8 | 41 |
| 2020 Noviembre | 23 | 19 | 42 |
| 2020 Octubre | 21 | 8 | 29 |
| 2020 Septiembre | 34 | 13 | 47 |
| 2020 Agosto | 24 | 17 | 41 |
| 2020 Julio | 13 | 11 | 24 |
| 2020 Junio | 21 | 18 | 39 |
| 2020 Mayo | 19 | 9 | 28 |
| 2020 Abril | 21 | 11 | 32 |
| 2020 Marzo | 23 | 9 | 32 |
| 2020 Febrero | 4 | 2 | 6 |
| 2019 Mayo | 0 | 1 | 1 |
| 2019 Marzo | 10 | 0 | 10 |
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