Successful treatment of disseminated granuloma annulare with methotrexate

Conflicts of interest: none declared. Madam, Granuloma annulare is an idiopathic dermatosis clinically manifested as well‐defined annular skin‐coloured to erythematous papules and plaques with histological findings of granulomatous inflammation, collagen degeneration and mucin deposition. Disseminated granuloma annulare usually affects middle‐aged or older individuals. Compared with localized granuloma annulare, the disseminated variant is less likely to resolve spontaneously and is often refractory to treatment.1 A 67‐year‐old white woman presented 10 years earlier with numerous mildly pruritic lesions diffusely involving her arms, abdomen, buttocks, legs and feet, characteristic of disseminated granuloma annulare (Fig. 1). Histological examination revealed a superficial and deep dermal interstitial infiltrate of lymphocytes and histiocytes with focal mild degeneration of collagen. Her past medical history was significant only for osteoarthritis. Full blood count, metabolic panel including fasting glucose, lipid panel and urinalysis were unremarkable. Although sarcoidosis was considered, the distinct and characteristic histological findings along with characteristic morphology and distribution allowed for diagnosis of disseminated granuloma annulare.