Granuloma Annulare

What is Granuloma Annulare?

Granuloma annulare is a very rare autoimmune condition that is shown on the skin through red bumps that are arranged in a ring or a circle. They are usually seen on the hands and feet and are benign.  There are no known causes and happens in healthy individuals.   Sometimes it is presented in those with diabetes or thyroid disease.  It has also been associated with rheumatic arthritis, Addison’s disease and systematic lupus erythematosus.   Some feel there is  a correlation between  allergies to wheat gluten, copper,  and tetanus vaccinations and granuloma annulare.     Others feel that animal bites, sun exposure, infections, tuberculosis skin tests and hepatitis all could result in granuloma annulare.

There are many types of granuloma annulare:

  • Localized granuloma annulare-  Tends to effect children to middle aged adults.  It is  seen most commonly on the dorsal or lateral surfaces of the fingers, hands, elbows, ankles and feet.  This is the most common form of granuloma annulare, with 75% of all cases of granuloma annulare being localized.   It is seen particularly in woman, with lesions being up to 2 inches in diameter.
  • Generalized granuloma annulare-  Tends to effect woman  in their 50s and 60s.  There are more than 10 skin lesions, usually hundreds.  This is often itchy.  Up to 15% of those with generalized granuloma annulare will have it over large portions of their bodies.   These can persist for 3 or 4 years, or longer in some cases.
  • Patch type granuloma annulare- Tends to effect woman between the ages of 30 and 70 years of age. Flat or slightly palpable red brown skin lesions will be on the skin.
  •  Subcutaneous granuloma annulare-  Tends to effect children the most.  Girls are effected twice as much as boys, with lesions often seen on the lower legs.  Instead of a rash, a  bump will be produced.  It is usually 1.5 inches in diameter.
  • Perforating granuloma annulare- Usually seen on the hands. Papules will most likely be present.

If you suspect that you do have any type of granuloma annulare, make an appointment with your doctor.  The doctor will be able to exam the skin and tell if granuloma annulare is present.  A skin biopsy may be taken to confirm what the doctor suspects.

Granuloma Annulare Treatment

There is usually not a treatment for granuloma annulare.  Within a few months, the skin lesions should go away.  However, if the rash does bother you there are many things that can be done for  treatment.  You may wish to ask your doctor about  corticosteroid creams or ointments.  These will be prescription strength.  They will not only help the rash disappear but make it go away in a more timely manner.  The doctor may advise you to cover the area to make the treatment more effective.

Corticosteroid injections can also be used.  The injections will be injected directly into the skin lesions.  These are usually used if the skin is thicker and the symptoms are greater.   Your doctor may also suggest freezing the granuloma annulare.  Liquid nitrogen will be used for this. This will also stimulate the growth of new skin.

Light therapy can be used for patients with granuloma annulare.  The lesions will be exposed to certain kinds of lights, or laser treatments.  Many have found this treatment to be effective.

Oral medications can be used in severe cases.  They could be used to prevent the immune system from having reactions in those individuals that have rheumatoid arthritis or who have received organ transplants.


Reference sources:

1. University of Rochester Medical Center 

2. Mayo Clinic


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