Granuloma annulare

By Mayo Clinic staff

• Definition
• Symptoms
• Causes
• Risk factors
• Preparing for your appointment
• Tests and diagnosis
• Treatments and drugs

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Definition

Granuloma annulare (gran-u-LOW-muh an-u-LAR-e) is a skin condition that most commonly consists of raised, reddish or skin-colored bumps (lesions) that form ring patterns — usually on your hands and feet.

The cause of granuloma annulare is unknown. In some people, the condition might be triggered by minor skin injuries or certain types of medications. Some types of granuloma annulare occur most commonly in adults, while other varieties typically affect children.

In most cases, granuloma annulare isn't itchy or painful, so no treatment is necessary. The lesions usually disappear on their own within two years. If you are bothered by how the lesions look, your doctor can prescribe medications that will speed their disappearance.

Symptoms

The signs and symptoms of granuloma annulare can vary, depending on the variety:

• Localized. This is the most common type of granuloma annulare. The lesion borders have a circular or semicircular shape, with a diameter up to 2 inches (5 centimeters). It occurs most commonly on the hands, feet, wrists and ankles of young adults, particularly women.
• Generalized. Up to 15 percent of the people who have granuloma annulare have lesions over a large portion of their bodies — including the trunk, arms and legs. This variety is more likely to be itchy and most often affects adults.
• Subcutaneous. Occurring predominantly in young children, this type of granuloma annulare produces a firm lump under the skin instead of a rash. The lump is usually less than 1.5 inches (3.8 centimeters) in diameter.

When to see a doctor
Call your doctor if your skin develops reddish bumps (lesions) in ring patterns that don't go away within a few weeks.

Causes

The cause of granuloma annulare is unknown. But in some people, the condition may be triggered by:

• Animal or insect bites
• Infections, including hepatitis
• Tuberculin skin tests
• Vaccinations
• Sun exposure

Risk factors

Granuloma annulare is occasionally associated with diabetes or thyroid disease, most often when lesions are numerous or generalized.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases you may be referred to a specialist in skin conditions (dermatologist).

What you can do
Before your appointment, you might want to write a list of answers to the following questions:

• Have you recently traveled to a new area or spent significant time outdoors?
• Do you have pets, or have you recently had contact with new animals?
• Are any family members or friends having similar symptoms?
• What medications or supplements do you take regularly?

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did your skin condition first appear?
• Does your rash cause any discomfort? Does it itch?
• Have your symptoms become worse or stayed the same over time?
• Have you been treating your skin condition with any medications or creams?
• Does anything seem to improve — or worsen — your symptoms?
• Do you have any other health conditions, such as diabetes or thyroid problems?

Tests and diagnosis

In many cases, your doctor can diagnose granuloma annulare by examining the affected skin. To confirm a case of granuloma annulare, your doctor may take a small sample of the affected skin (skin biopsy) to examine under a microscope.

Treatments and drugs

In most cases, no treatment is necessary for granuloma annulare. Most lesions disappear within a few months, and rarely last more than two years. If the appearance of the rash bothers you, your doctor may recommend:

• Corticosteroid creams or ointments. Prescription-strength products may help improve the appearance of the lesions and speed their disappearance. Your doctor may direct you to cover the cream with bandages or an adhesive patch, to increase the effectiveness of this treatment.
• Corticosteroid injections. If the skin lesions are thicker and your symptoms are greater, your doctor may inject corticosteroids directly into the lesions to help them disappear faster.
• Freezing the lesions. Applying liquid nitrogen to the affected area can help remove the lesions and stimulate the growth of new skin.
• Light therapy. Exposing the lesions to particular types of light is sometimes helpful. Certain types of laser treatments also work for some people.
• Oral medications. In severe cases, especially when the lesions are widespread, your doctor might prescribe drugs used to prevent immune system reactions in people who have rheumatoid arthritis or who have received an organ transplant.

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