title: Acute-onset, painful acral granuloma annulare: a report of 4 cases and a discussion of the clinical and histologic spectrum of the disease.
abstract: BACKGROUND
  Granuloma annulare is a benign cutaneous inflammatory disease of unknown etiology most commonly presenting on the hands and feet and consisting of asymptomatic to mildly pruritic, flesh-colored to erythematous annular plaques. To our knowledge, an acute-onset, painful acral eruption has not been previously recognized.
  
  
  METHODS
  We report 4 patients who presented with acute-onset, painful acral granuloma annulare.
  
  
  CONCLUSIONS
  It is possible for granuloma annulare to present as a painful eruption with an acute onset and an acral distribution. Biopsy results are a crucial factor when establishing the diagnosis of this atypical clinical presentation of granuloma annulare.
authors.affiliation: Division of Dermatology, Department of Medicine, School of Medicine, University of Louisville, KY 40202, USA.
authors.forename: Nicole Vessels
authors.initials: NV
authors.lastname: Brey
authors.forename: Janine
authors.initials: J
authors.lastname: Malone
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Callen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D005385:Fingers; D016460:Granuloma Annulare / Q000150:complications / Q000473:pathology*; D006801:Humans; D008663:Metacarpus; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology*