brand logo

Am Fam Physician. 2022;106(1):85-86

Author disclosure: No relevant financial relationships.

A 26-year-old woman presented with mildly tender, circular, hyperpigmented skin lesions with small bumps affecting the dorsum of both hands (Figure 1) and the medial aspect of the left foot. The lesions, which were first noticed approximately five months earlier, had an insidious onset and grew slowly. There was no pruritus or drainage.

The patient had mild arthralgias in her hands and feet. She had no recent travel or exposure to wilderness areas. She had a history of tobacco use. Laboratory workup was negative for inflammation.

Question

Based on the patient’s history and physical examination findings, which one of the following is the most likely diagnosis?

  • A. Annular lichen planus.

  • B. Arthropod bite.

  • C. Cutaneous sarcoid.

  • D. Granuloma annulare.

  • E. Tinea corporis.

Discussion

The answer is D: granuloma annulare, a benign, noninfectious, asymptomatic, granulomatous skin condition. Although the pathogenesis is unclear, it is theorized to be related to a hyper-sensitivity reaction. Iatrogenic processes such as drug reactions and bacterial and viral exposures may be associated triggers.1 Granuloma annulare is more common in women and individuals younger than 30 years. A form of granuloma annulare presenting as subcutaneous nodules is more common in children.2

Already a member/subscriber?  Log In

Subscribe

From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Issue Access

$59.95
  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at https://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. Email submissions to afpphoto@aafp.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at https://www.aafp.org/afp/photoquiz

Continue Reading

More in AFP

More in PubMed

Copyright © 2022 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.