- Backs of the hands and tops of the fingers
- Tops of the feet
- Around the elbows
- Around the knees
Granuloma annulare appears as small (1–3 mm), skin-colored or pink bumps. These bumps, which are smooth rather than scaly, may occur singly or in groups. Each bump may expand in size, leaving a shallow indentation in the center, which may be lighter or darker than your normal skin color. Alternatively, several small bumps may merge to form a ring, 1–5 cm in diameter. Healed lesions of granuloma annulare do not leave scars.
Granuloma annulare does not usually have any symptoms, though some individuals may experience itching.
Rarely, granuloma annulare may be widespread, called generalized granuloma annulare. Generalized granuloma annulare tends to appear in adults over 30 years old. The condition may consist of hundreds to thousands of 1–2 mm bumps that appear on the arms, legs, and upper trunk. These skin-colored or pink bumps may be quite itchy.
- Numbing the skin with an injectable anesthetic.
- Sampling a small piece of skin by using a flexible razor blade, a scalpel, or a tiny cookie cutter (called a "punch biopsy"). If a punch biopsy is taken, a stitch (suture) or two may be placed and will need to be removed 6–14 days later.
- Having the skin sample examined under the microscope by a specially trained physician (dermatopathologist).
If the lesions of granuloma annulare are uncomfortable or unsightly, the physician may try one of the following:
- A prescription-strength steroid or cortisone cream
- Steroid injections directly into the lesions
- Freezing with liquid nitrogen (cryotherapy)
- Non-steroid topical anti-inflammatory creams such as tacrolimus or pimecrolimus
- Treatment with carbon dioxide laser
- Oral steroids, such as prednisone
- Oral retinoids, such as isotretinoin
- Ultraviolet light
- Other oral medications such as potassium iodide, dapsone, nicotinamide, pentoxifylline, hydroxychloroquine, or cyclosporine