Clinical Manifestations and Management of Pediatric Granuloma Annulare: A Systematic Review

Objective: To determine the clinical manifestations, management, and outcomes of pediatric granuloma annulare (GA).

Study design: We searched MEDLINE via PubMed, Latin American and Caribbean Health Sciences, and EMBASE from inception to January 2021. We included all original reports of patients <18 years of age with a diagnosis of GA and all original reports describing any intervention, including topical or systemic agents, in these patients. Two authors independently extracted sociodemographics and clinical data of the study patients and treatment(s) used.

Results: Of 2440 reports screened, 202 were included (836 patients). The mean age was 5.7 (SD 3.8) years and F:M ratio 1.3:1. Localized GA (n = 384/821, 46.8%) and subcutaneous GA (n = 353/821, 43.0%) were the most prevalent subtypes. The most affected site was lower limbs (n = 272/568, 47.9%). Suspected triggering factors were mainly local trauma. Diabetes was associated in 22 (2.6%) patients. The rate of spontaneous remission was high (n = 140/155, 90.3%), with a median time of 12 months. The most frequent therapies were surgery and topical corticosteroids. Recurrence was observed in 38.3% (n = 168/439) of patients, regardless of treatment.

Conclusions: Pediatric GA frequently resolves spontaneously yet displays a high recurrence rate. Hence, in asymptomatic forms, invasive therapies are not recommended as first-line treatment.