Granuloma Annulare: a Review of the Literature
DOI:
https://doi.org/10.17921/1415-6938.2020v24n4p410-415Resumo
Granuloma annulare (GA) is a form of noninfectious skin granuloma, first described in 1895 as a rash in the form of a ring (annular), with regular, rounded edges. Around 50% of the cases are cured spontaneously within 2 years, however, a percentage of patients suffer from recurrent lesions or persistence for years. The pathogenesis of GA lesions is not well understood, with studies linking its expression to the presence of histocompatibility genes (HLA)-Bw35 or AH8.1 allele. These genes are related to the production of TNF-α (Tumor Necrosis Factor-α) by mononuclear cells. The pathogenesis includes the migration of macrophages to the dermis, the presence of cytokines, late hypersensitivity reaction, defects in regulating the neutrophil chemotaxis and degradation of the connective tissue. Its outbreak may be linked to predisposing factors, such as diabetes mellitus, thyroid changes and viral infectious diseases. The macrophages present in GA lesions may receive stimuli that result in its modulation to M1 or M2 activation patterns. The study of the M1 and M2 modulation mechanism in the lesion is important for an understanding of GA development.
Keywords: Granuloma Annulare. Macrophage. Immunology. Pathogenesis and Modulation.
Resumo
O Granuloma Anular (GA) é um tipo de granuloma cutâneo não infeccioso, que foi descrito em 1895, como uma exantema em formato de anel (anular), de bordas regulares e arredondadas. Cerca de 50% dos casos têm cura espontânea em 2 anos, mas parte dos pacientes apresentam recidivas das lesões ou persistência por anos. A patogênese das lesões do GA é pouco conhecida. Estudos relacionam sua expressão à presença de genes de histocompatibilidade (HLA)-Bw35 ou AH8.1, que são relacionados à produção de TNF-α (Tumor necrosis factor - α), pelas células mononucleares. A patogênese também inclui migração de macrófagos para derme, presença de citocinas, reação de hipersensibilidade tardia, defeito na quimiotaxia de neutrófilos e degradação do tecido conectivo. O surgimento das lesões pode estar associado a fatores predisponentes, como diabetes mellitus, alterações tireoidianas e doenças infecciosas virais. Os macrófagos presentes nas lesões de GA podem sofrer estímulos que acarretem sua modulação para os padrões de ativação M1 ou M2. O estudo de tais mecanismo de modulação é importante para a compreensão da instalação e desenvolvimento do GA nos pacientes afetados.
Palavras-chave: Granuloma Anular. Macrófagos. Modulação. Imunologia e Patogênese.
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