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Interstitial granulomatous dermatitis

This presents with linear cords ("the rope sign") or annular plaques, and on histology shows a diffuse "busy" dermal infiltrate rather than a discrete necrobiotic granuloma.

Interstitial granulomatous drug reaction

Similar to IGD, but with a clear history of a triggering medication.

Necrobiosis lipoidica

While histologically similar, NL has a very specific clinical appearance of a waxy, atrophic, yellowish plaque on the shins.

Palisading neutrophilic and granulomatous dermatosis

This is part of the same spectrum, often associated with systemic lupus, and is distinguished by a more prominent neutrophilic infiltrate on biopsy.

Papular granuloma annulare

The papules of GA are typically smaller and form annular rings, and the histology shows palisaded granulomas around mucin, not the necrobiosis of this condition.

Perforating dermatosis

This is characterized by the transepidermal elimination of dermal material, presenting as umbilicated papules with a central keratotic plug.

Rheumatic fever

The subcutaneous nodules of rheumatic fever are deep, painless nodules over bony prominences in the setting of acute rheumatic fever.

Rheumatoid nodulosis

These are deep, subcutaneous nodules in patients with rheumatoid arthritis, histologically showing a palisaded granuloma, but the clinical term here describes a more diffuse or ulcerative skin process.

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