Granuloma annulare

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

  • Alternative Names
    • Pseudorheumatoid nodule - subcutaneous granuloma annulare; GA

  • Causes
    • GA most often affects children and young adults. It is slightly more common in females.

      The condition is usually seen in otherwise healthy people. Sometimes, it may be associated with diabetes or thyroid disease. The exact cause of GA is unknown.

  • Symptoms
    • GA usually causes no other symptoms, but the rash may be slightly itchy.

      People 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.

      In rare cases, GA appears as a firm nodule under the skin of the arms or legs. In some cases, the rash spreads all over the body.

  • Exams and Tests
    • Your health care provider may think you have a fungal infection when looking at your skin as the ring shape may look like ringworm. A skin scraping and KOH test can be used to tell the difference between GA and a fungal infection.

      You may also need a skin punch biopsy to confirm the diagnosis of GA.

  • Treatment
    • GA can resolve on its own. You may not need treatment for GA, 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 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.

  • Outlook (Prognosis)
    • Most GA disappears without treatment within 2 years. But, the rings can remain for many years. The appearance of new rings years later is not uncommon.

  • When to Contact a Medical Professional
    • Call your provider if you notice a ring anywhere on your skin that does not go away within a few weeks.

  • References
    • Habif TP. Cutaneous manifestations of internal disease. In: Habif TP, ed. Clinical Dermatology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 26.

      Patterson JW. The granulomatous reaction pattern. In: Patterson JW, ed. Weedon's Skin Pathology. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap 7.

      Recica HF, Iichyshyn A. Granuloma annulare. In: Lebwohl MG, Heymann WR, Jones-Berth J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 91.