Subcutaneous granuloma annulare on the heel: A case report and review of the Japanese published work.

Subcutaneous granuloma annulare is a rare variant of granuloma annulare. It mostly presents as painless subcutaneous nodule(s) with or without annular lesions on the lower legs and scalp of children. We herein report a case of a 5-year-old Japanese girl with subcutaneous granuloma annulare on the right heel. The lesions improved in 15 months without any therapy. We also review 85 reported cases of subcutaneous granuloma annulare between 1 and 85 years of age in the Japanese published work. The most susceptible age was 5 years and below; however, a small peak occurred from the 40s to 60s. Subcutaneous granuloma annulare was more frequent in females (male : female ratio, 6:11). Sixty-five cases (76.4%) had multiple lesions; the average number of lesions was 4.8 +/- 5.8. The most affected site was the lower legs (28 cases), followed by the dorsum of the foot (21 cases) and scalp (17 cases). The heel was an unusual location; only two cases of sole subcutaneous granuloma annulare have been reported. Twenty-one cases revealed a classical dermal change along with a subcutaneous change. Patients with classical dermal lesions were younger (P < 0.0001) and had a smaller number of lesions (P < 0.05) than those without the lesions. The lesion(s) resolved in 24 of the 44 untreated cases within 1 week to 19 months. Refractory or recurrent lesion(s) were seen in four of 21 treated cases and in four of 44 untreated cases. Because subcutaneous granuloma annulare lesions often resolve spontaneously without treatment, invasive treatments should be avoided.