Concomitant occurrence of patch granuloma annulare and classical granuloma annulare

Granuloma annulare (GA) is characterized clinically as annularly-distributed, erythematous papules on the extremities in children and adolescents. GA is recognized histologically as palisading granulomas with central degenerated collagen and mucin deposits. Here, we present a case of concomitant occurrence of patch GA (PGA), the most rare type of GA, and classical GA in a patient. A 60-year-old man was referred to our hospital for asymptomatic eruptions on the upper arms, forearms, right flank and right lateral chest. Clinical examination revealed annular erythematous plaques composed of numerous small papules on bilateral upper arms and forearms. Moreover, an indurative, exudative erythematous to violaceous plaque was present on the right lateral chest and right flank. Histopathology of the former was compatible with palisade-type GA, and the latter interstitial-type GA. This is the first report of PGA concomitant with "classical" annular papular lesions.