Granuloma Annulare

What is granuloma annulare?

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

What are the types of granuloma annulare?

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

• Localized granuloma annulare. Localized granuloma annulare is the most common form of granuloma annulare. It causes a circular rash on your skin limited to one area.
• Generalized (disseminated) granuloma annulare. Bumps develop over a larger area of your skin, like your whole forearm, instead of a smaller, more concentrated rash.
• Subcutaneous granuloma annulare. Lumps develop under your skin.
• Perforating granuloma annulare. Painful bumps form on your hands and fingers.
• Patch granuloma annulare. Flat areas of rash form in patches on your skin.

Who does granuloma annulare affect?

Granuloma annulare most commonly affects children and young adults, though it may affect people of all ages. It affects women and people assigned female at birth twice as much as men and people assigned male at birth.

You may be more likely to have granuloma annulare if you have diabetes, especially Type 1 insulin-dependent diabetes.

You may also be more likely to have granuloma annulare if you have a thyroid disease, including thyroiditis, hypothyroidism and thyroid adenoma.

If a healthcare provider diagnoses you with granuloma annulare — particularly generalized granuloma annulare — ask them if screening for other conditions sometimes seen in people with granuloma annulare is right for you.

Perforating granuloma annulare is more common in Hawaii.

How does granuloma annulare affect my body?

In skin of color, you may have dark areas of skin (hyperpigmentation) once the inflammation goes away.

Chronic granuloma annulare can also affect your emotions. It can affect you psychosocially (how society and social groups affect your thoughts and emotions) and psychologically (how you think about yourself and your behavior). You may experience stress, anxiety and depression.

What are the symptoms of granuloma annulare?

Granuloma annulare symptoms vary according to what type you have.

Localized granuloma annulare

Symptoms of localized granuloma annulare include:

• Small bumps on your skin that appear right before a rash develops.
• Circular rash on your skin that may start as small circles that later merge.
• The rash may appear red, pink, purple or the same color as your unaffected skin.

Generalized granuloma annulare

Symptoms of generalized granuloma annulare include:

• Bumps that appear over a large area of your skin.
• Bumps that join to form large, discolored areas.

Subcutaneous granuloma annulare

Symptoms of subcutaneous granuloma annulare include:

• Small lumps under your skin.
• Lumps that may grow quickly.
• Firm, round and painless lumps.
• Red, pink or discolored lumps.

Perforating granuloma annulare

Symptoms of perforating granuloma annulare include:

• Small, painful, scaly bumps on your hands or fingers.
• Itchy or painful bumps.
• Bumps that leak fluid.
• Widespread bumps that connect to form large rashes.

Patch granuloma annulare

Symptoms of patch granuloma annulare include:

• Red, reddish-brown or purple flat areas of rash.
• A rash appears in one or more areas on your skin.

What causes granuloma annulare to flare up?

Healthcare providers and medical researchers don’t know the exact cause of granuloma annulare. Some research suggests that your immune system might have an inappropriate response to an injury to your skin.

Healthcare providers and medical researchers also think the following may trigger granuloma annulare:

• Insect bites.
• Certain medications, like allopurinol (Aloprim®, Zyloprim®).
• Some diseases, like human immunodeficiency virus (HIV) and hepatitis C.

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

Is granuloma annulare caused by stress?

Some research suggests that chronic stress may cause granuloma annulare. Reducing your stress may help prevent granuloma annulare. Try the following tips to help reduce your stress:

• Count to 10 as you take a deep breath.
• Exercise daily.
• Drink caffeine and alcohol in moderation.
• Sleep eight hours a night.
• Eat healthy foods.
• Try to have a positive attitude.
• Journal every day.
• Talk about your life with friends, family and a therapist.

Is granuloma annulare contagious?

No, granuloma annulare isn’t contagious. You can’t spread granuloma annulare to another person through skin-to-skin contact.

How is granuloma annulare diagnosed?

A healthcare provider will perform a physical examination of your skin.

After a physical examination, they may perform a skin biopsy to confirm their diagnosis. They’ll remove a small sample of your skin. Then, they’ll send the skin sample to a laboratory so other healthcare providers can examine it under a microscope to help determine what’s causing your rash.

How do you get rid of granuloma annulare?

For most people, granuloma annulare goes away on its own without treatment. It usually disappears completely within two years. However, in some people, the rash can come back later.

If granuloma annulare causes large areas of rash on your skin or deep, large lumps under your skin, your healthcare provider may recommend treatment.

The purpose of treatment is to help control itching or pain. Treatments may speed up the time it takes for your rash to fade.

Treatment options include:

• Medications. Certain medications can help clear your skin by reducing inflammation. Your healthcare provider may recommend corticosteroids, isotretinoin (Absorica®, Zenatane®) or tacrolimus (Protopic®). You may apply these medications directly onto your skin as a cream or ointment, or your healthcare provider may give them to you as an injection. Drugs used to treat malaria, such as hydroxychloroquine, may help reduce the appearance of rashes on your skin.
• PUVA therapy. This is a type of light therapy. Your healthcare provider combines a drug called psoralen with ultraviolet A light (PUVA). Psoralen makes your skin more sensitive to light. The ultraviolet (UV) light waves can slow down the growth of skin cells, which may stop the granuloma annulare from growing. Another name for PUVA therapy is photochemotherapy.
• Cryotherapy. Your healthcare provider will freeze the affected areas of your skin using specialized equipment. Cryotherapy stops the rash from growing.
• Laser therapy. Your healthcare provider will use a special laser to target your affected skin. The laser heats your skin, which may decrease inflammation and prevent your rash from spreading.
• Vitamin E tablets. Your healthcare provider may recommend vitamin E tablets if you don’t respond to other treatment options.

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

Can a change in diet get rid of granuloma annulare?

Changes to your diet may help improve granuloma annulare. Some studies suggest that restricting the amount of lipids (cholesterol and triglycerides) in your diet may cause granuloma annulare to disappear faster. This may also be true if you have diabetes, elevated lipids in your blood or other conditions that healthcare providers sometimes see in people with granuloma annulare.

Are there any home remedies for granuloma annulare?

There’s very little research on whether home remedies can help treat granuloma annulare. However, proper skin care can help improve your skin’s overall health.

The following can help improve your skin’s overall health:

• Use a humidifier.
• Use a mild soap for your bath or shower.
• Take baths or showers with lukewarm water, not hot water.
• Apply a moisturizing cream or ointment immediately after drying your skin to help seal in the moisture.
• Avoid itchy clothing, such as wool.

How can I prevent granuloma annulare?

There isn’t any way to prevent granuloma annulare.

What can I expect if I have granuloma annulare?

For most people, granuloma annulare clears up on its own without treatment, and it doesn’t leave any scars or traces behind.

However, granuloma annulare is a chronic disease. Lesions often return, and rashes often return in the same place. If your lesions or rashes come back, they usually disappear faster than when they first appeared.

What questions should I ask my healthcare provider?

• How can you tell that I have granuloma annulare?
• If I don’t have granuloma annulare, what other skin condition might I have?
• What treatment options do you recommend?
• What are the side effects of the treatment options?
• Should I see a dermatologist or another specialist?

What’s the difference between granuloma annulare and ringworm?

Granuloma annulare is a skin condition that causes a raised, discolored rash or bumps to develop on your skin. Healthcare providers don’t know the exact cause of granuloma annulare. Your immune system may play a role in the development of this condition. You can’t spread granuloma annulare to another person through skin-to-skin contact.

Ringworm is a skin condition that causes an itchy, discolored, ring-shaped rash to form. A fungus causes ringworm — it’s not actually a worm. It’s highly contagious. You can pick up ringworm through direct contact with an infected person or animal or a contaminated surface, like a locker room floor or sweaty gym clothes. Ringworm tends to be scalier than granuloma annulare.

A note from Cleveland Clinic

Granuloma annulare is an annoying skin condition that can make you feel self-conscious. However, it’s common and very normal, and it usually goes away on its own within two years. It’s a good idea to pay attention to your skin. If you have any questions, your healthcare provider is there to help.