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GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA
A Journal on Dermatology and Sexually Transmitted Diseases
Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,014
Giornale Italiano di Dermatologia e Venereologia 1999 December;134(6):639-42
Perforating granuloma annulare (PGA) in HIV-seropositive patient
D'antuono A., Lehmann J., Passarini B., De Tommaso S., Carlà E.
Università degli Studi - Bologna, Dipartimento di Medicina Clinica, Specialistica e Sperimentale, Sezione di Dermatologia
Perforating granuloma annulare (PGA) is an uncommon variant of granuloma annulare of unknown aetiology characterized by erythematous or flesh-colored papules in annular groups localized most frequently on hands and feet. These lesions present a central umbilication with ulceration and release of necrobiotic material. In the literature only a few cases of PGA in HIV-seropositive patients have been found. There are characteristic immunologic abnormalities common to all HIV-seropositve patients. These include anergy to delayed-type hypersensitivity skin tests, a polyclonal increase in IgG, and depletion of peripheral helper\inducer T lymphocytes. This results in a significant reduction in cell-mediated immunity. This immunosuppression has lead to a profound increase in the number of opportunistic infections and neoplasms. Umbert and Winkelmannn have suggested that cell-mediated immunity is involved in the pathogenesis of granuloma annulare. There is some evidence suggesting a delayed hypersensitivity reaction and a vascular injury in the pathogenesis of perforating granuloma annulare, but the role of cellular-mediated immunity in the pathogenesis of PGA is still discussed. The case is described of homosexual HIV-positive patient observed for the onset of a papular and papular-vescicular eruption localized on hands and feet. General condition and laboratory findings indicated a severe immunodeficiency. The histopathologic findings of some of these lesions confirmed the suggestive pattern of PGA. In this patient the dermatosis was autoresolving. There are two types of PGA: one type is characterized by multiple umbilicated papular lesion (P-type); the other type appears less frequently, consisting in ulcerations covered by crust (U-type). In these patients the following progressive stages may be observed:erythematous papules, which evolve into yellowish, pustular appearing lesion, which subsequently discharge a clear fluid. Histopathologic study showed perforation of the epidermis and transepithelial release of the abnormal necrobiotic material. Although the disease is usually self-limited, a wide array of treatment methods has been employed to try to hasten resolution.