Periocular subperiosteal deep granuloma annulare in a child.

A 2-year-old child presented with a painless subperiosteal periorbital mass of 6 months' duration. This was associated with several small cutaneous nodules that resolved spontaneously before surgical excision of the orbital lesion. Excisional biopsy of the lesion revealed a deep granuloma annulare in a subperiosteal location along the superior orbital rim. The patient did well after surgery, with no evidence of recurrence after 18 months. Deep granuloma annulare is a rare lesion often confused with rheumatoid nodule. It has not previously been reported in a subperiosteal location around the orbit. Although granuloma annulare is typically benign and often self-limiting, in some cases it can be associated with systemic disease.