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This article deals with two new cases of perforating generalized granuloma annulare characterized, from a clinical and biological standpoint, by a long course of evolution for one case and the presence of diabetes and dyslipidemia for the other case. Histologic study confirms the possible coexistence of typical granuloma annulare lesions with epidermic corbelar aspects pinching necrotic material which could lead to complete epidermic perforation. Based on the study of previous cases in the literature, the process of transepidermic elimination and the actual pathophysiologic concepts of granuloma annulare are reviewed. From the therapeutic standpoint, if the first case did not appear to profit from the administration of an alkylating agent, the second case seems to be presently improved through gluco-lipid re-equilibrium associated with lipocaic heparin.
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