Generalized granuloma annulare with clinical presentation resembling Erythema Gyratum Repens in a diabetic female patient

Generalized granuloma (GA) is an inflammatory benign cutaneous disease of unknown etiology that may manifest different clinical features. The most common presentation or classic form of the disease is flesh colored, annular, grouped papules. They usually are on the extremities especially on the lateral or dorsal surfaces of the fingers, hands, wrists, ankles, and insteps. Several clinical manifestations have been reported for this disease. Variants, such as localized, generalized, subcutaneous, linear, perforating and patch GA, have been reported. The generalized form may present as either disseminated, individual, usually skin-colored papules arise anywhere on the skin surface especially trunk, or annular to circinate erythematous lesions that resemble erythema multiform, erythema migrans, erythema annulare centrifugum and erythema gyratum repens. In latter group, the popular quality is less obvious than the erythema. In these lesions, rings may spread centrifugally and central hyper pigmentation may be present. This report describes a case of generalized GA in a 46-year-old diabetic woman with annular and circinate erythematous plaques resembling erythema annulare. At first according to clinical and histological findings, diagnosis of erythema gyratum repens had been suggested but later, GA was confirmed.