Coexistence of granuloma annulare and chronic spontaneous urticaria*

Granuloma annulare (GA) is frequently associated with diabetes mellitus, malignant diseases and infectious diseases. 1 A recent study has shown that GA may be observed concurrently with autoimmune disease, including systemic sclerosis and dermatomyositis. 2 Herein, we describe a patient with the rare coexistence of granuloma annulare and chronic spontaneous urticaria. A 59-year old woman presented with a 5-month history of annular lesions on her right arm at our outpatient clinic. She had been admitted to our department 30 years earlier becauseof pruritic papules and was diagnosed with chronic spontaneous urticaria. Dermatological examination revealed annular erythema-tous to violaceous plaques on the right forearm and urticarial pap-ules and plaques on the trunk (Figure 1). Routine laboratory parameters and thyroid antibodies were within the normal ranges. But autologous serum test was positive. Histopathological examination of punch biopsy obtained from annular lesion showed focal degen-Figure 1: Annular erythematous to violaceous plaques on the right forearm and urticarial papules, and plaques on the trunk