A rare presentation of subcutaneous granuloma annulare: a case report of bilateral palmar and dorsal hand nodules with successful management.

Introduction and importance: Granuloma annulare (GA) is a benign, self-limited, chronic inflammatory dermatosis predominantly affecting children and young adults. Subcutaneous granuloma annulare (SGA) is a rare variant, chiefly observed in children, characterized by firm, asymptomatic nodules typically located on the lower extremities, buttocks, or scalp. Involvement of the palms or soles is exceptionally rare.

Case presentation: We report the case of a healthy teenager presenting with bilateral subcutaneous nodules on both the palmar and dorsal surfaces of the hands. Histopathological examination confirmed the diagnosis of SGA. Given the patient's aesthetic concerns, a treatment regimen of intralesional corticosteroid injections was initiated, leading to complete resolution of the lesions without recurrence during follow-up.

Clinical discussion: This case represents the first documented instance of SGA involving both palmar and dorsal surfaces of the hands bilaterally in a healthy adolescent. While SGA is usually self-limited, cosmetic concerns or discomfort may necessitate therapeutic intervention. Intralesional corticosteroids have been employed with variable success in such cases.

Conclusion: This case underscores the importance of considering SGA in the differential diagnosis of subcutaneous hand nodules in pediatric patients, even in atypical locations such as the palms and dorsal hands. It also highlights the efficacy of intralesional corticosteroid treatment in achieving satisfactory cosmetic outcomes without recurrence.