Indurated Lesion on Child's Metacarpophalangeal Joint

THE CASE: A 6-year-old girl is brought for evaluation of an asymptomatic indurated erythematous lesion that erupted on the metacarpophalangeal joint of one hand 2 weeks ago. The patient has no history of trauma or exposure and is otherwise healthy.

(Answer and discussion on next page.)

Granuloma annulare is the correct answer.

DISCUSSION: This patient has granuloma annulare, a self-limited eruption whose cause is unknown. A low-potency topical corticosteroid was prescribed, and the lesion gradually improved over the course of several weeks.

Insect bites and contact dermatitis are pruritic. Eczema is pruritic and scaly. This lesion has none of the features that characterize warts, such as a pebbling texture and, in some cases, punctate hemorrhages that suggest thrombosed capillaries.

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Case and images courtesy of David L. Kaplan, MD, University of Missouri Kansas City, University of Kansas.