Non-infectious Granulomatous Diseases of the Skin and their Associated Systemic Diseases: An Evidence-based Update to Important Clinical Questions

Elena Balestreire Hawryluk; Leonid Izikson; Joseph C. English III


Am J Clin Dermatol. 2010;11(3):171-181. 

In This Article

8. Conclusion

Non-infectious granulomatous diseases of the skin encompass a wide range of cutaneous and systemic manifestations. Several clinical questions were reviewed with the best available evidence-based data. Generalizations that can be made from our investigation are the following: (i) atypical GA in elderly patients should be evaluated with age-appropriate malignancy screening tests; (ii) NL patients should be screened for impaired glucose metabolism and diabetic-associated NL patients need monitoring for ocular and renal disease; (iii) accelerated rheumatoid nodulosis is not only caused by methotrexate but also etanercept, infliximab, and azathioprine; (iv) NXG is more commonly associated with MGUS and not myeloma but monitoring for malignant transformation of the MGUS is prudent; (v) although IGD and PNGD have been confused both clinically and histologically, routine screening for autoimmunity, malignancy, and medications should be initiated if either entity is suggested on histologic evaluation; (iv) all patients diagnosed with cutaneous sarcoidosis require screening for systemic involvement and dermatologists treating patients with sarcoidosis should be attentive to possible malignancy development; and (vii) MCD is in temporal discordance with associated gastrointestinal involvement.


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