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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

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. Patients over the age of 40 may often experience more intense itching with widespread granuloma annulare.

Exams 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 and is not a dangerous condition, 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.

Outlook (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.

When to Contact a Medical Professional

Call your health care 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. 5th ed. Philadelphia, PA: Elsevier Mosby; 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: Elsevier Saunders; 2007:chap. 658.

Review Date:7/30/2014
Reviewed By:Richard J. Moskowitz, MD, dermatologist in private practice, Mineola, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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