We report a 60-year-old Caucasian female with a 2-year history of diffused granuloma annulare (GA), who presented for the simultaneous occurrence of genital lichen sclerosus (LS) and autoimmune thyroiditis (AT). In our opinion this combination is not just coincidental but may share similar immunopathological mechanisms. 1. Introduction GA is one of the “ten noninfectious granulomatous diseases” of the skin, a broad group of distinct reactive inflammatory conditions that share important similarities and that have significant associations with systemic diseases [1]. GA is a benign self-limiting, relatively common dermatosis, typically characterized by an annular arrangement of erythematous or flesh-coloured papules, affecting patients of all ages. Incidence is highest in women, with a ratio of 2.3 to 1.0 over men [2]. The cause of GA is still unknown, but it has been reported following traumas, malignancy, viral infections (including human immunodeficiency virus HIV, Epstein-Barr virus (EBV), and herpes zoster (HZV)), insect bites, and tuberculosis skin tests [3]. The pathogenesis of GA remains still obscure. Possible pathogenetic factors suggested include humoral and delayed type hypersensitivity, vascular damage, metabolic disorder, or primary collagen and/or elastin alteration mediated through an immunologic mechanism [3]. LS is a chronic inflammatory mucocutaneous disease, commonly associated with HLA type B40 related to high incidence of autoimmune diseases, that mainly affects women in the 5th decade but may occur in all age groups, including adolescents and prepubertal children. Its exact prevalence is unknown, but estimates range from 1？:？60 to 1？:？1000. [4]. The etiology is still obscure, although genetic and autoimmune factors, as well as infections, have been implicated in its pathogenesis. It is most commonly seen on the female genital skin, but it also occurs on extragenital areas. Most patients complain of itching and, less frequently, burning sensation, dyspareunia, dysuria, and painful defecation [5]. Autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disorder, usually resulting in dysfunction (hyperfunction, hypofunction, or both) of the thyroid gland. In some patients, other organ-specific and non-organ-specific autoimmune syndromes are associated with autoimmune thyroid disease, including pernicious anemia, vitiligo, myasthenia gravis, primary adrenal autoimmune disease, celiac disease, rheumatoid arthritis, or lupus [6]. We report a case of GA, AT, and LS in a woman and discuss their comorbidity. 2. Case
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