Granuloma Annulare

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Images of Granuloma Annulare

Overview

Granuloma annulare is a common skin condition where bumps appear over the joints and the backs of the hands. Its cause is not known, and most outbreaks of granuloma annulare go away after a few years with or without treatment.

Who's at risk?

Although granuloma annulare can occur in people of any race and at any age, it is most commonly seen in children and young adults. Females are slightly more likely than males to develop granuloma annulare.

Signs and Symptoms

Granuloma annulare occurs most frequently over the joints or in areas that have had mild injury. The most common locations for granuloma annulare include:

  • Backs of the hands and tops of the fingers
  • Tops of the feet
  • Around the elbows
  • Around the knees
The lesions of granuloma annulare are usually found in the same areas on both sides of the body (symmetrically).

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 dent in the center, which may be lighter or darker than the normal skin. Granuloma annulare may also appear as several small bumps that 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 people may have itching.

Self-Care Guidelines

If the lesions of granuloma annulare are itchy, an over-the-counter cortisone cream may be helpful.

When to Seek Medical Care

If your child has bumps or a ring-shaped lesion on the skin for more than several weeks, see his or her doctor or a dermatologist who can tell whether the bumps are due to granuloma annulare or conditions such as ringworm, insect bites, or even Lyme disease.

Treatments Your Physician May Prescribe

If the diagnosis is not obvious, the doctor may perform a skin biopsy. The procedure involves:

  1. Numbing the skin with an injectable anesthetic.
  2. 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.
  3. Having the skin sample examined under a microscope by a specially trained physician (dermatopathologist).
Once the diagnosis of granuloma annulare is confirmed, you and your child's physician may decide not to treat it. Up to 70% of cases of granuloma annulare resolve on their own (spontaneously) within 2 years, even without treatment. However, the lesions may come back in up to 40% of people, usually at the same location as the original rash.

If the lesions of granuloma annulare are uncomfortable or unsightly, the physician may try:
  • 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

Trusted Links

Clinical Information and Differential Diagnosis of Granuloma Annulare

References

Bolognia, Jean L., ed. Dermatology, pp.1460-1463. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.980-984. New York: McGraw-Hill, 2003.