Granuloma Annulare

Granuloma annulare is a raised, bumpy, or ring-shaped lesion, which can occur singly or in groups on the skin. It is more common in children and young adults, although it may affect people of all ages. Women are twice as likely as are men to develop granuloma annulare.

Granuloma annulare may be pearly white, skin-colored, red, or purple. It is most often in an isolated area, but may appear as several “bumps” spread over the body. Beginning as a round, firm, smooth bump, the lesion becomes a circular ring with a clear center, which resembles the shape of a doughnut. While granuloma annulare can develop on any part of the skin, it appears most often on the tops of the hands and feet, elbows, and knees. It usually does not peel or itch and for that reason, can often go unnoticed.

No one knows what causes granuloma annulare, but a reaction in the immune system may play a role. There may be a relationship between granuloma annulare and diabetes. So far, this remains unproven. Having granuloma annulare does not mean that you are ill. Most people do not have symptoms, and the only sign is a spot on the skin. A few experience mild itching

Granuloma annulare is most often confused with ringworm. It also may look like insect bites. One insect bite in particular may resemble granuloma annulare. This is the initial lesion of Lyme disease, which is called erythema migrans. For this reason, it is important for your dermatologist to inspect these lesions to make the correct diagnosis.

Sometimes your dermatologist diagnoses granuloma annulare by examining the lesion. A biopsy, a small sample of skin examined under a microscope, may be performed to confirm the diagnosis. To rule out other medical conditions, your dermatologist may recommend blood work.

As most people do not have symptoms, treatment is not necessary. The spots on the skin generally disappear on their own without leaving scars. Within a few months, most lesions are gone. Occasionally, clearing takes years. If lesions are widespread or cosmetically undesirable, there are several treatment options. Your dermatologist may prescribe a steroid cream or inject steroids directly into the spot to help it disappear faster. Steroids can thin the skin and should be used according to your dermatologist’s directions.

PUVA, a type of ultraviolet light therapy, may be used to treat widespread disease. This therapy is given under the close supervision of a dermatologist. The major side effect of PUVA is a sunburn-type reaction. Other oral medications may be indicated. It is important to see a dermatologist and get the correct diagnosis and the appropriate therapy.