Granuloma annulare of the external ear, a rare mimic of malignancy: two case reports




Granuloma annulare, Granulomatous dermatosis, Ear disease, Helix, Antihelix


Granuloma annulare (GA) is a granulomatous inflammatory largely cutaneous and less often subcutaneous condition with varied presentations ranging from localized to disseminated forms manifesting as erythematous papules or plaques affecting all ages and primarily involving the extremities. GA may affect other sites such as the face and cases limited to the orbit and ear are exceedingly rare. No consistent causative factor has been identified although there is an established association with diabetes mellitus, autoimmune diseases, infections, malignancies or localized trauma. The chief histological pattern of palisaded or interstitial granulomatous reaction is diagnostic, providing infections such as mycobacterium have been excluded. Standardized treatment is elusive and different modalities including local/intralesional steroids, cryo/photo/laser therapy or oral retinoids/antibiotics have been used with variable response. We report two cases of GA limited to the ear adding to the 13 previously published cases.


Kim J, Lee S, Yoon, T. A Case Of Atypical Granuloma Annulare Involving Both Ears. Ann Dermatol. 2009;21:413-5.

Raghava N, Mitchard JR, Youngs RP. Granuloma annulare presenting as multiple nodes on the pinna. J Laryngol Otol. 2004;118:640-2.

Dias Coelho J, Viana I, Correia S. Bilateral granuloma annulare of the external ear. Eur J Dermatol. 2010;20:409-10.

Mills A, Chetty R. Auricular Granuloma Annulare A consequence of trauma? Am J Dermatopathol. 1992;14:431-3.

Gerdes M, Blom H, Van der Laan J, Vinke J. Relapsing Papules on the Antihelix of the Left Ear. JAMA Otolaryngol Head Neck Surg. 2013;139:1071-2.

Zuo AJ, Yao R, Xiong L, Zhang MH. A case of multiple granuloma annulare on the auriculae. J Clin Dermatol. 2014;43:613-4.

Chiu F, Muir J, Correy J. Perforating granuloma annulare of the ear – an example of the utility of teledermatology. Aust J Dermatol. 2018;59:49.

Farrar CW, Bell HK, Dobson CM, Sharpe GR. Perforating granuloma annulare presenting on the ears. Br J Dermatol. 2002;147:1026-8.

Oro-Ayude M, Hernandez Cancela RM, Florez A. Pearly White Papules on the Antihelix. Avanzando Juntos En Dermatologia. 2020;111:603-4.

Shim WH, Kim SH, Jung DS, Ko HC. Auricular granuloma annulare induced by repeated occupational traumas. Korean J Dermatol. 2010;48:616-9.

Yong-Sun C, Joo-Ik K, Song KH, Nam, KH, Park J, Yun SK, Kim HU. Auricular granuloma annulare in a child. Int J Dermatol. 2014;53:218-20.

Scott AR, Lee LN, Duncan LM, Kieff DA. Subperiosteal deep granuloma annulare of the orbital rim. The Laryngoscope. 2009;119:231.

Patrascu V, Giurca C, Ciurea RN, Georgescu CV. Disseminated granuloma annulare: study on eight cases. Rom J Morphol Embryol. 2013;54:327-31.

Cohen P. Granuloma annulare, relapsing polychondritis, sarcoidosis and systemic lupus erythematosus: conditions whose dermatologic manifestations may occur as hematologic malignancy-associated mucocutaneous paraneoplastic syndromes. Int J Dermatol. 2006;45:70-80.

Baykal C, Yazganoglu D. Granulomatous Lesions. In: Baykal C, Yazganoglu D. Dermatological diseases of the Nose and Ears. 1st edition. Berlin, Heidelberg: Springer. 2010;134.






Case Reports