Subcutaneous granuloma annulare of the extremities in children.

OBJECTIVE To familiarize surgeons to the natural history and treatment of granuloma annulare of the extremities in children. DESIGN Case review and follow-up by appointment and questionnaire. SETTING The Children's Hospital of Eastern Ontario, a tertiary referral centre. PATIENTS Twenty-seven children (23 girls, 4 boys) seen between 1983 and 1998 with subcutaneous granuloma annulare, proven pathologically. The mean age at initial presentation was 8.3 years (range from 1.8 years to 16.7 years). The mean follow-up was 45 weeks (range from 1 week to 5 years). INTERVENTION Biopsy excision of the lesions. OUTCOME MEASURES The incidence multiple lesions, the commonest site of occurrence and the incidence of recurrence. RESULTS Six children presented with multiple lesions for a total of 46 lesions. The anterior pretibial area was the most frequently affected site (16 lesions), followed by the ankle (6 lesions) and the long finger (4 lesions). Five patients suffered recurrence of the lesion, with a total of 7 lesions recurring. CONCLUSIONS Subcutaneous granuloma annulare is a benign inflammatory skin lesion occurring most frequently in the anterior pretibial area in children, predominantly girls. The incidence of recurrence and of multiple lesions is high. Biopsy is required for definitive diagnosis. The lesion resolves spontaneously without treatment.