title: Remission of generalized erythematous granuloma annulare after improvement of hyperlipidemia and review of the Japanese literature.
abstract: Granuloma annulare has been associated with systemic disease including diabetes mellitus. We report a case of a 62-year-old Japanese woman with generalized erythematous granuloma annulare who showed remission after substantial improvement in hyperlipidemia following a strict lipid-lowering diet. The lesion appeared in the lower abdomen one year before current presentation and subsequently spread to other areas of the trunk despite treatment with topical steroid and oral epinastine hydrochloride. Physical examination showed a well-demarcated erythematous plaque measuring 10 cm in diameter with fine scales on the left abdomen, and slightly indurated pinkish plaques of up to 5 cm in diameter on the right side of the abdomen and axillae. Clinical laboratory tests showed mild glucose intolerance (HbA1c 6.2%), mild liver dysfunction (AST: 86 IU/L, ALT: 76 IU/l), slight hypercholesterolemia (total cholesterol: 235 mg/dl), and severe hyperlipidemia (triglyceride: 962 mg/ml). Histopathological examination of the lesions showed homogenization of collagen fibers and granulomatous infiltrates between fibers in the upper and middle dermis. A diagnosis of generalized erythematous granuloma annulare was established based on the clinical and histopathological findings, especially with the distribution on more than one anatomic site. A lipid-lowering diet for three months resulted in major improvement of hyperlipidemia and remission of the skin lesions. A review of generalized erythematous granuloma annulare in the Japanese literature indicated a well-known association of granuloma annulare with diabetes mellitus, however, the relation with hyperlipidemia was described only recently. This case suggests a possible relationship between granuloma annulare and hyperlipidemia, with possible improvement of granuloma annulare with a lipid-lowering diet.
authors: Departments of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors: Soko
authors: S
authors: Watanabe
authors: Departments of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors: Masaru
authors: M
authors: Tanaka
authors: Departments of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors: Ken
authors: K
authors: Kobayashi
authors: Departments of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors: Mizuki
authors: M
authors: Sawada
authors: Departments of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors: Sumiko
authors: S
authors: Ishizaki
authors: Tsurui Clinic of Internal Medicine, Tokyo, Japan.
authors: Koji
authors: K
authors: Tsurui
authors: Department of Pathology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors: Mariko
authors: M
authors: Fujibayashi
keywords: generalized erythematous granuloma annulare; glucose intolerance; hyperlipidemia