title: Granuloma annulare on the palms: a clinicopathological study of seven cases.
abstract: BACKGROUND
  Granuloma annulare (GA), a common dermatological condition of unknown etiology, affecting all ages. Involvement of the palms appears rare, posing a diagnostic challenge. This study was conducted to document various clinical and histopathological features of GA on the palms.
  
  
  OBJECTIVE
  To study clinical and histopathological variations in granuloma annulare on palms.
  
  
  METHODS
  A total 7 patients from our outpatient department with lesions of GA, exclusively on the palms, were studied over a period of 6 months from March 2011 to August 2011. Total of 8 biopsies were studied. In each patient, diagnosis was made on clinico-pathological correlation. Various clinical and histopathological features were analyzed.
  
  
  RESULTS
  An average age of onset was 47 years, male: female ratio was 1.33: 1, and average disease duration was 9 months. Pain was the most common symptom. Clinically, the most common presentation was pseudovesicles. Histologically, both classic palisading and interstitial pattern were seen. Perineural granulomas, perieccrine granulomas, elastophagocytosis were seen additionally. In 5 out of 7 patients, diagnosis was missed clinically.
  
  
  CONCLUSIONS
  GA on palms poses a diagnostic challenge due to variable presentations. Histopathology is of vital importance for correct diagnosis and treatment. GA should be considered in differential diagnosis of papular lesions on palms.
authors: Department of Dermatology, Seth GS Medical College and KEM Hospital, Parel, Maharashtra, Mumbai, India.
authors: Rameshwar
authors: R
authors: Gutte
authors: Dimple
authors: D
authors: Kothari
authors: Uday
authors: U
authors: Khopkar
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D016460:Granuloma Annulare / Q000150:complications / Q000473:pathology*; D006225:Hand / Q000473:pathology*; D006229:Hand Dermatoses / Q000150:complications / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology