Acute-onset, painful acral granuloma annulare - A report of 4 cases and a discussion of the clinical and histologic spectrum of the disease

Background: Granuloma annulare is a benign cutaneous inflammatory disease of unknown etiology most commonly presenting on the hands and feet and consisting of asymptomatic to mildly pruritic, flesh-colored to erythematous annular plaques. To our knowledge, an acute-onset, painful acral eruption has not been previously recognized. Observations: We report 4 patients who presented with acute-onset, painful acral granuloma annulare. Conclusions: It is possible for granuloma annulare to present as a painful eruption with an acute onset and an acral distribution. Biopsy results are a crucial factor when establishing the diagnosis of this atypical clinical presentation of granuloma annulare.