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Annular plaque of beads distribution in the thorax in an elderly patient associated with poorly controlled diabetes mellitus
Placa anular de distribución en forma de collarete en el tronco de un paciente anciano con diabetes mellitus mal controlada
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The patient associated type 2 diabetes mellitus (DM) poorly controlled with insulin therapy. The physical examination showed an asymptomatic, large, collarette-like annular shape, erythematous and indurated plaque on the anterior trunk (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The skin biopsy revealed an inflammatory palisading granulomatous pattern associated with collagen degeneration, and a slight perivascular lymphocytic infiltrate, compatible with annular granuloma (AG). The laboratory study showed fasting glucose levels of 341<span class="elsevierStyleHsp" style=""></span>mg/dl and a glycosylated haemoglobin of 14.3%. The lipid and thyroid profile study and the viral hepatic and HIV serology were normal or negative. AG is a benign, non-contagious cutaneous granulomatous disease, usually asymptomatic and self-healing. Clinically, it presents with annular distribution papules and/or plaques, predominantly in the female sex. AG is not usually associated with systemic disease, but this variant, generalized AG, has been mainly related to DM and thyroid diseases, although the lipid, HCV, HBV and HIV profile study is also recommended. Despite adequate control of associated diseases, such as DM, skin lesions manifest an independent progression, and the treatments described in the medical literature (topical and/or systemic corticosteroids, phototherapy, isotretinoin, dapsone, pentoxifylline, hydroxychloroquine, cyclosporine, iodide potassium, nicotinamide, niacinamide, salicylic acid, esters of fumaric acid, and biological anti-TNF-α) have not shown to be very effective in clinical symptoms of generalized AG, like that of our patient.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Navarro Triviño FJ, González-Ruiz L, Garrido-Torres-Puchol V. Placa anular de distribución en forma de collarete en el tronco de un paciente anciano con diabetes mellitus mal controlada. 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