Generalized granuloma annulare with open comedones in photoexposed areas

Granuloma annulare (GA) is a noninfectious necrobiotic granuloma, which can present as localized or generalized patterns. We present a case of generalized GA with multiple large open comedones over the lesions in a woman with hypothyroidism and diabetes mellitus. GA is associated with collagen and elastic-fibre damage, which may lead to loss of follicular support and resultant open comedone formation, analogous to solar elastosis or senile comedones. The rapid recovery of our patient after treatment with of oral hypoglycaemics supports the role of insulin resistance as a predisposing factor for GA.