Granuloma multiforme: Difference between revisions
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'''Granuloma multiforme''' is a cutaneous condition most commonly seen in central [[Africa]], and rarely elsewhere, characterized by [[skin lesion]]s that are on the upper trunk and arms in sun-exposed areas.<ref name="Andrews"/>{{rp|707}} It may be confused with [[tuberculoid leprosy]], with which it has clinical similarities. The condition was first noted by Gosset in the 1940s, but it was not until 1964 that Leiker coined the term to describe "a disease resembling leprosy" in his study in Nigeria.<ref name="Kumari 2009"/> |
'''Granuloma multiforme''' is a cutaneous condition most commonly seen in central [[Africa]], and rarely elsewhere, characterized by [[skin lesion]]s that are on the upper trunk and arms in sun-exposed areas.<ref name="Andrews"/>{{rp|707}} It may be confused with [[tuberculoid leprosy]], with which it has clinical similarities. The condition was first noted by Gosset in the 1940s, but it was not until 1964 that Leiker coined the term to describe "a disease resembling leprosy" in his study in [[Nigeria]].<ref name="Kumari 2009"/> |
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== Signs and symptoms == |
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The upper trunk and arms are the main areas affected. The clinical picture differs greatly. Typically, the first lesions are [[Papule|papules]], which quickly develop into polycyclic and [[annular lesions]] with papular or nodular margins. There might also be plaques that are elevated. Lesions typically leave behind residual [[Hypopigmentation|hypopigmented]] [[macules]] and extend with central healing over months or years. It irritates and is itchy, particularly when new lesions are developing. The lesions differ from [[leprosy]] in that they do not exhibit nerve enlargement, local sensation impairment, or impaired sweating. Also, the lesions never become ulcerated. The illness is a cause of cosmetic disfigurement, but it does not affect the patient's overall health.<ref name="Sandhu Saraswat Gupta Shukla"/> |
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==Causes== |
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Granuloma multiforme is primarily thought to be caused by cumulative photodamage to the dermal [[collagen]], with the lesions in this condition almost exclusively occurring in sun-exposed areas.<ref name="Kumari 2009"/> |
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==Diagnosis== |
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The best way to understand the histologic features is to look at a [[Skin biopsy|radial biopsy]] with a raised border and central zone. The absence of [[Elastic fiber|elastic fibers]], the disease's hallmark, is best shown in the central zone using an elastic tissue stain like [[Verhoeff-Van Gieson stain|Verhoeff-Van Gieson's]]. A zone of transition with granulomatous infiltration is visible on the elevated border. Both a perivascular [[Lymphocyte|lymphocytic]] infiltrate and elastic tissue [[phagocytosis]] are seen within the [[Giant cell|giant cells]].<ref name="an uncommon differential"/> |
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Other conditions that should be taken into account in the differential diagnosis of granuloma multiforme include [[sarcoidosis]], [[necrobiosis lipoidica diabeticorum]], [[granuloma annulare]], and the typical mimic of [[tuberculoid leprosy]],<ref name="Kumari 2009"/> which has sensory impairment and thickening of the nerve trunk but no degenerated [[collagen]].<ref name="in India"/> In younger age groups, [[granuloma annulare]] is characterized by asymptomatic lesions that histopathologically show increased mucin deposition encircled by a granulomatous zone with a scarcity of [[Giant cell|giant cells]] with fewer [[nuclei]].<ref name="Kumari 2009"/> [[Necrobiosis lipoidica]] is characterized by a yellow-colored appearance of the plaques, [[telangiectasia]], involvement of the lower limbs, as well as the presence of [[fibrosis]] mixed with [[necrosis]], vessel wall changes, and fat deposition in the deep [[reticular dermis]].<ref name="in India"/> |
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==Treatment== |
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Although [[Topical steroid|topical steroids]] have been tried, there is currently no effective treatment for granuloma multiforme.<ref name="an uncommon differential"/> |
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== See also == |
== See also == |
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* [[Skin lesion]] |
* [[Skin lesion]] |
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* [[Granuloma annulare]] |
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== References == |
== References == |
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<ref name="Meyers 1970">{{cite journal |last1=Meyers |first1=Wayne |last2=Connor |first2=DH |last3=Shannon |first3=R |title=Histologic characteristics of granuloma multiforme (Mkar disease). Including a comparison with leprosy and granuloma annulare. Report of first case from Congo (Kinshasa) |journal=International Journal of Leprosy and Other Mycobacterial Diseases |date=January 1970 |volume=38 |issue=3 |pages=241–249 |url=https://www.researchgate.net/publication/17649604 }}</ref> |
<ref name="Meyers 1970">{{cite journal |last1=Meyers |first1=Wayne |last2=Connor |first2=DH |last3=Shannon |first3=R |title=Histologic characteristics of granuloma multiforme (Mkar disease). Including a comparison with leprosy and granuloma annulare. Report of first case from Congo (Kinshasa) |journal=International Journal of Leprosy and Other Mycobacterial Diseases |date=January 1970 |volume=38 |issue=3 |pages=241–249 |url=https://www.researchgate.net/publication/17649604 }}</ref> |
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<ref name="Sandhu Saraswat Gupta Shukla">{{cite journal | last=Sandhu | first=Kamaldeep | last2=Saraswat | first2=Abir | last3=Gupta | first3=Somesh | last4=Shukla | first4=Rajeev | last5=Handa | first5=Sanjeev | title=Granuloma multiforme | journal=International Journal of Dermatology | volume=43 | issue=6 | date=2004 | issn=0011-9059 | doi=10.1111/j.1365-4632.2004.01979.x | pages=441–443}}</ref> |
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<ref name="an uncommon differential">{{cite journal | last=Bhatia | first=Shibani | last2=Shenoi | first2=Shrutakirthi D | last3=Pai | first3=Kanthilatha | last4=Ps | first4=Srilatha | title=Granuloma multiforme: an uncommon differential for leprosy | journal=Tropical Doctor | volume=49 | issue=1 | date=2019 | issn=0049-4755 | doi=10.1177/0049475518803191 | pages=55–58}}</ref> |
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<ref name="in India">{{cite journal |last1=Cherian |first1=S |title=Granuloma multiforme in India |journal=International journal of leprosy and other mycobacterial diseases : official organ of the International Leprosy Association |date=December 1990 |volume=58 |issue=4 |pages=719–721 |pmid=2280121}}</ref> |
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==Further reading== |
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* {{cite journal | last=Poudyal | first=Yogesh | last2=Shah | first2=Anita | title=Granuloma Multiforme: A Rare Granulomatous Disease | journal=Case Reports in Dermatological Medicine | publisher=Hindawi Limited | volume=2019 | date=2019 | pmid=31687221 | doi=10.1155/2019/5485034 | doi-access=free | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800944/ | access-date=December 30, 2023 | ref=none}} |
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* {{cite journal | last=Sharma | first=Yugal K | last2=Ankadavar | first2=Nandini S | last3=Malik | first3=Garima | last4=Patel | first4=Ruchir J | title=A Rare Report of Granuloma Multiforme | journal=Indian Journal of Dermatology | publisher=Wolters Kluwer -- Medknow Publications | volume=61 | issue=1 | pmid=26951760 | doi=10.4103/0019-5154.174168 | doi-access=free | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763666/ | access-date=December 30, 2023 | ref=free}} |
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== External links == |
== External links == |
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{{Medical resources |
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{{Cutaneous ketatosis, ulcer, atrophy, necrobiosis, and vasculitis}} |
{{Cutaneous ketatosis, ulcer, atrophy, necrobiosis, and vasculitis}} |
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[[Category:Monocyte- and macrophage-related cutaneous conditions]] |
[[Category:Monocyte- and macrophage-related cutaneous conditions]] |
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{{Cutaneous-condition-stub}} |
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Revision as of 16:28, 30 December 2023
| Granuloma multiforme | |
|---|---|
| Other names | Mkar disease and Granuloma multiforme (Leiker)[1] |
| Specialty | Dermatology  |
Granuloma multiforme is a cutaneous condition most commonly seen in central Africa, and rarely elsewhere, characterized by skin lesions that are on the upper trunk and arms in sun-exposed areas.[2]: 707 It may be confused with tuberculoid leprosy, with which it has clinical similarities. The condition was first noted by Gosset in the 1940s, but it was not until 1964 that Leiker coined the term to describe "a disease resembling leprosy" in his study in Nigeria.[3]
Signs and symptoms
The upper trunk and arms are the main areas affected. The clinical picture differs greatly. Typically, the first lesions are papules, which quickly develop into polycyclic and annular lesions with papular or nodular margins. There might also be plaques that are elevated. Lesions typically leave behind residual hypopigmented macules and extend with central healing over months or years. It irritates and is itchy, particularly when new lesions are developing. The lesions differ from leprosy in that they do not exhibit nerve enlargement, local sensation impairment, or impaired sweating. Also, the lesions never become ulcerated. The illness is a cause of cosmetic disfigurement, but it does not affect the patient's overall health.[4]
Causes
Granuloma multiforme is primarily thought to be caused by cumulative photodamage to the dermal collagen, with the lesions in this condition almost exclusively occurring in sun-exposed areas.[3]
Diagnosis
The best way to understand the histologic features is to look at a radial biopsy with a raised border and central zone. The absence of elastic fibers, the disease's hallmark, is best shown in the central zone using an elastic tissue stain like Verhoeff-Van Gieson's. A zone of transition with granulomatous infiltration is visible on the elevated border. Both a perivascular lymphocytic infiltrate and elastic tissue phagocytosis are seen within the giant cells.[5]
Other conditions that should be taken into account in the differential diagnosis of granuloma multiforme include sarcoidosis, necrobiosis lipoidica diabeticorum, granuloma annulare, and the typical mimic of tuberculoid leprosy,[3] which has sensory impairment and thickening of the nerve trunk but no degenerated collagen.[6] In younger age groups, granuloma annulare is characterized by asymptomatic lesions that histopathologically show increased mucin deposition encircled by a granulomatous zone with a scarcity of giant cells with fewer nuclei.[3] Necrobiosis lipoidica is characterized by a yellow-colored appearance of the plaques, telangiectasia, involvement of the lower limbs, as well as the presence of fibrosis mixed with necrosis, vessel wall changes, and fat deposition in the deep reticular dermis.[6]
Treatment
Although topical steroids have been tried, there is currently no effective treatment for granuloma multiforme.[5]
See also
References
- ^ Meyers, Wayne; Connor, DH; Shannon, R (January 1970). "Histologic characteristics of granuloma multiforme (Mkar disease). Including a comparison with leprosy and granuloma annulare. Report of first case from Congo (Kinshasa)". International Journal of Leprosy and Other Mycobacterial Diseases. 38 (3): 241–249.
- ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6.
- ^ a b c d Kumari, Rashmi; Devinder Mohan, Thappa; Chougule, Abhijit; Adityan, Balaji (2009). "Granuloma multiforme: A report from India". Indian Journal of Dermatology, Venereology and Leprology. 75 (3): 296–299. doi:10.4103/0378-6323.51259. PMID 19439886.
- ^ Sandhu, Kamaldeep; Saraswat, Abir; Gupta, Somesh; Shukla, Rajeev; Handa, Sanjeev (2004). "Granuloma multiforme". International Journal of Dermatology. 43 (6): 441–443. doi:10.1111/j.1365-4632.2004.01979.x. ISSN 0011-9059.
- ^ a b Bhatia, Shibani; Shenoi, Shrutakirthi D; Pai, Kanthilatha; Ps, Srilatha (2019). "Granuloma multiforme: an uncommon differential for leprosy". Tropical Doctor. 49 (1): 55–58. doi:10.1177/0049475518803191. ISSN 0049-4755.
- ^ a b Cherian, S (December 1990). "Granuloma multiforme in India". International journal of leprosy and other mycobacterial diseases : official organ of the International Leprosy Association. 58 (4): 719–721. PMID 2280121.
Further reading
- Poudyal, Yogesh; Shah, Anita (2019). "Granuloma Multiforme: A Rare Granulomatous Disease". Case Reports in Dermatological Medicine. 2019. Hindawi Limited. doi:10.1155/2019/5485034. PMID 31687221. Retrieved December 30, 2023.
- Sharma, Yugal K; Ankadavar, Nandini S; Malik, Garima; Patel, Ruchir J. "A Rare Report of Granuloma Multiforme". Indian Journal of Dermatology. 61 (1). Wolters Kluwer -- Medknow Publications. doi:10.4103/0019-5154.174168. PMID 26951760. Retrieved December 30, 2023.