Granuloma annulare

Definition

Granuloma annulare is a long-term (chronic) skin disease consisting of a rash with reddish bumps arranged in a circle or ring.

Causes, incidence, and risk factors

Granuloma annulare most often affects children and young adults. It is slightly more common in females.

The condition is usually seen in otherwise healthy people. Occasionally, it may be associated with diabetes or thyroid disease. Its cause is unknown.

Symptoms

Granuloma annulare usually causes no other symptoms, but the rash may be slightly itchy.

Patients usually notice a ring of small, firm bumps (papules) over the backs of the forearms, hands, or feet. Occasionally, they may find a number of rings.

Rarely, granuloma annulare may appear as a firm nodule under the skin of the arms or legs. In some cases, the rash may spread all over the body.

Signs and tests

Your health care provider may think you have a fungal infection when looking at your skin. A skin scraping and KOH test can be used to tell the difference between granuloma annulare and a fungal infection.

You may also need a skin biopsy to confirm the diagnosis of granuloma annulare.

Treatment

Because granuloma annulare usually causes no symptoms, you may not need treatment except for cosmetic reasons.

Very strong steroid creams or ointments are sometimes used to clear up the rash more quickly. Injections of steroids directly into the rings may also be effective. Some health care providers may choose to freeze the bumps with liquid nitrogen.

People with severe or widespread cases may need ultraviolet light therapy or medicines that suppress the immune system.

Expectations (prognosis)

Most granuloma annulare disappears without treatment within 2 years. Sometimes, however, the rings can remain for many years. The appearance of new rings years later is not uncommon.

Calling your health care provider

Call your health care provider if you notice a ring anywhere on your skin that does not go away within a few weeks.

Figures

Granuloma annulare - close-upGranuloma annulare on the eyelidGranuloma, annulare on the elbowGranuloma, annulare on the legs

References

Habif TP. Cutaneous manifestations of internal disease. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 26.

Morelli JG. Diseases of the dermis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap. 658.

Revision

Last reviewed 7/11/2012 by Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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