Granulomatous Dermatitis and Systemic Disease: An Association to Consider

Granuloma annulare and interstitial granulomatous dermatitis are granulomatous dermatoses with variable clinical appearances. Granuloma annulare is associated with diabetes mellitus, metabolic syndrome, chronic infections and malignancies, while two Japanese reports described unusual cases of interstitial-type Granuloma annulare in setting of Sjogren syndrome. Interstitial granulomatous dermatitis was associated with rheumatoid arthritis, systemic lupus erythematosus and autoantibodies. We report a case-series of six patients with granuloma annulare or interstitial granulomatous dermatitis, in which half of the patients were diagnosed with Sjogren syndrome, while all of them presented ANA-positivity and the majority reported arthralgia. In many cases, granuloma annulare showed interstitial-type histology, arising challenges in differential diagnosis with interstitial granulomatous dermatitis. The overlap of clinical and histological features of granuloma annulare and interstitial granulomatous dermatitis can be explained considering them as a broad disease spectrum, including also the other forms of reactive granulomatous dermatitis. These conditions should be considered as an indicator of possible systemic disorders or other immunological dyscrasias, for which patients must be screened. Sjogren syndrome may be associated with granuloma annulare also in Caucasians.