7 year old boy having this presentation for past 3 months. Treated as Tinea from another clinic without any response. No history of itching completely asymptomatic, increased during this summer vacation. Borders are indurated and no scaling. 1. Diagnosis 2. Possible Etiology. 3. Work up needed 4. Treatment. To avoid confusion, it's not Tinea.

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Granuloma annulare
1. granuloma annulare commonly present with groups of 1- to 2-mm papules that range in color from flesh-toned to erythematous, often in an annular arrangement over distal extremities. Lesions most commonly manifest on the dorsal surfaces of the feet, hands, and fingers, and on the extensor aspects of the arms and legs. 2.Granuloma annulare has been hypothesized to be associated with tuberculosis, insect bites, trauma, sun exposure, thyroiditis, vaccinations, and viral infections, including HIV, Epstein-Barr virus, hepatitis B virus, hepatitis C virus, and herpes zoster virus, chronic stress. However, these suggested etiologic factors remain unproven. 3. According to suspected etiology, rule out diabetes, biopsy can be done to confirm. 4. Topical steroid are the mainstay Pimecrolimus or tacrolimus can be tried. Cryotherapy Narrow band UVB Phototherapy is safer in children with extensive lesions.
granuloma anulare. though unknown in itiology. search for associated disease. is that affected area of finger swollen? if yes then to r/o cox.
granuloma annulare is type vasculitis.spontaneous recovery is seen.localised variety seen in children.disseminated in adults. high recurrence.
dds are all annular lesions 1.granuloma annulare 2.erythema annulare centrifugam 3.bt Hansen's with reaction 4.sweet syndrome.
erythem annulare centrifugam hypersensitivity to fungal antigen.tt with antifungals
?Granuloma annularae ?annular sarcoidosis
SUGGESTIVE OF GRANULOMA ANNULARE
if not responding add oral steroids
Granuloma annulare
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