Granulomi anulari disseminati: efficacia della terapia con solfoni

A case of disseminated granuloma annulare in a woman aged 55 is reported. Albeit suffering from hypothyroidism (multinodular goiter), the cutaneous eruption, which had been lasting for 1 year and was unresponsive to systemic corticosteroids and cyclosporin, did not depend on the endocrine disorder itself. Only palmoplantar districts were spared by confluent papulonodular plaques. No other abnormality could be detected. The histological picture was that of diffuse dermal dermatitis with rare foci of palisading granulomatous groupment of round cells. Therapeutic success was achieved through the administration of 4,4'-diaminodiphenylsulphone (DDS, Dapsone; 200/day for 10 days, then followed by 100 mg/day for 20 days). After 10 days of DDS treatment, the lesions were almost completely disinfiltrated and cleared. No relapse after a follow-up of 8 months was observed. Clinical and histopathological differential diagnosis of disseminated granuloma annulare, as well as proper treatment options for this puzzling rare condition are discussed, with emphasis on the practical choice of treatments for rare, stubbornly persistent diseases, and the methodology of the evaluations of related clinical results.