Granuloma Annulare

Overview

What is granuloma annulare?

Granuloma annulare is a benign (not cancer), often chronic (long-lasting) skin disorder in which inflammation in the skin causes a raised, discolored rash or lumps under the skin. In most cases, rashes form on the hands, feet and forearms.

Who is likely to have granuloma annulare?

Granuloma annulare most commonly occurs in children and young adults, although it can affect people of all ages. Women are affected more often than men.

One type of granuloma annulare, perforating granuloma annulare, is more common in Hawaii.

What are the types of granuloma annulare?

There are five main types of granuloma annulare. It is possible to develop more than one type of granuloma annulare at the same time.

  • Localized granuloma annulare: The most common form of the condition, localized granuloma annulare causes a circular rash on the skin that may begin as small circles that later merge together. You may notice several small bumps on your skin before developing a rash. The areas are usually discolored. The rash can appear red, pink, purple, or skin-colored.
  • Generalized granuloma annulare: Bumps develop over a larger area, like the whole forearm, instead of in a smaller, more concentrated rash. The bumps eventually join to form large, discolored areas.
  • Subcutaneous granuloma annulare: This type of granuloma annulare causes lumps to form under your skin. The lumps are usually firm and round. They are not painful. In most cases, lumps stay small, but they can grow quickly. Lumps are red, pink, or skin-colored.
  • Perforating granuloma annulare: Small, painful, scaly bumps form on the hands and fingers. In some cases, bumps are itchy or painful, and they leak fluid. Some people develop widespread bumps that connect and then form larger rashes.
  • Patch granuloma annulare: Red, reddish-brown, or purple flat areas of rash form on the skin. People may develop one or more areas of skin like this.

Symptoms and Causes

What causes granuloma annulare?

Doctors do not know the exact cause of granuloma annulare. Some research indicates your immune system may play a role in the development of this condition .

Doctors also think granuloma annulare is related to triggers, such as:

Some people develop granuloma annulare after exposure to environmental triggers like being out in the sun for a long time.

What are the symptoms of granuloma annulare?

For most people, granuloma annulare causes no symptoms except for a rash or a lump under the skin. However, some people experience itching or mild pain.

Diagnosis and Tests

How is granuloma annulare diagnosed?

Your doctor examines your skin in order to diagnose granuloma annulare. Your doctor may also take a sample of your skin (skin biopsy) to confirm your diagnosis and rule out other diseases or conditions.

Management and Treatment

How is granuloma annulare treated?

For most people, granuloma annulare goes away on its own without treatment. The condition usually disappears completely within two years. However, in some patients, the rash can recur after it has resolved.

If granuloma causes large areas of rash on yor skin, or deep, large lumps under your skin, your doctor may recommend treatment. The purpose of treatment is to help control the itching or pain. Treatments can potentially speed up the time it takes for the rash to fade, though this is not always seen.

  • Medications: Certain drugs can help clear your skin by reducing inflammation. Your doctor may recommend strong corticosteroids, isotretinoin (Absorica®, Zenatane®), or tacrolimus (Protopic®). Medications may be applied directly to your skin or given as an injection. Other drugs, such as those used to treat malaria, might help reduce the appearance of the rashy areas on your skin.
  • PUVA therapy: This type of light therapy uses a drug called psoralen, which is taken orally or given as a bath or soak. Then doctors expose your skin to UVA light. Psoralen makes your skin more sensitive to light. UV light can slow down the growth of skin cells, which in turn may stop the granuloma annulare from continuing to grow. PUVA therapy is sometimes called photochemotherapy.
  • Cryotherapy: Using specialized equipment, your doctor freezes the portion of your skin affected by granuloma annulare. This treatment tries to stop the skin patches from continuing to grow.
  • Laser therapy: Your doctor uses a special laser to target and to heat the skin. This is thought to decrease inflammation in the skin and prevent further spread of the rash.

For some people, granuloma annulare is difficult to treat. You may try several therapies before finding what works best for you.

Prevention

Can granuloma annulare be prevented?

There is no way to prevent granuloma annulare.

Outlook / Prognosis

What is the prognosis (outlook) for people with granuloma annulare?

In most cases, granuloma annulare clears up on its own without treatment, leaving no trace behind. Most areas of rash disappear within two years.

However, because granuloma annulare is a chronic disease, lesions often return. Rashes usually return in the same place. Recurring problem areas often disappear faster than first-time rashes.

Living With

When should I call my doctor?

If you notice a rash or deep lump developing on or under your skin, contact your doctor for a thorough evaluation. It is also important to contact your doctor if you notice skin rashes that bleed, get larger, are itchy or painful, or change appearance in any way.

Last reviewed by a Cleveland Clinic medical professional on 10/23/2018.

References

  • L. Cunningham, B. Kirby, A. Lally & P. Collins (2016) The efficacy of PUVA and narrowband UVB phototherapy in the management of generalised granuloma annulare, Journal of Dermatological Treatment, 27:2, 136-139.
  • American Academy of Dermatology. Granuloma annulare. (https://www.aad.org/public/diseases/rashes/granuloma-annulare#overview) Accessed 10/23/2018.
  • Merck Manual Professional Version. Granuloma annulare. (https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-inflammatory-skin-disorders/granuloma-annulare) Accessed 10/23/2018.
  • National Center for Advancing Translational Sciences. Granuloma annulare. (https://rarediseases.info.nih.gov/diseases/6546/granuloma-annulare) Accessed 10/23/2018.
  • National Organization for Rare Disorders. Granuloma annulare. (https://rarediseases.org/rare-diseases/granuloma-annulare/) Accessed 10/23/2018.

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