Typically asymptomatic, and presents as small grouped papules in an annular configuration.
Localised disease is the most common subtype; patients are often women in their 30s.
Most cases are self-limiting, with at least 50% resolving within 2 years. However, recurrences are common.
A possible association with underlying malignancy has been postulated, particularly in older patients with atypical or generalised clinical presentation such as palmar plaques or erythroderma. However, this association has been challenged in a recent cohort study.
Although evidence is limited, may be associated with thyroid disease, hyperlipidaemia, and diabetes.
Granuloma annulare (GA) is an uncommon benign condition of unknown aetiology. Lesions are typically described as dermal papules, which coalesce to form rings, and may be skin-coloured, pink, or violaceous; commonly found on the back of hands, ankles, knees, and elbows. A number of clinical variants exist. Histology is characteristic. Most cases are self-limiting.
History and exam
Key diagnostic factors
- asymptomatic grouped annular pink or flesh-coloured dermal papules
Other diagnostic factors
- flesh-coloured, pink, or brown macules or small papules
- soft-tissue nodules
- perforating papules, crusting or ulcerated lesions
- erythematous patches
- diabetes mellitus
- haematological malignancy
- herpes zoster
- thyroid disease
1st investigations to order
- clinical diagnosis
Investigations to consider
- skin biopsy
- fasting blood sugar
- thyroid function tests
- lipid screening
- hepatitis screen
- HIV testing
localised variant (classic annular rash)
generalised variant (widespread macular rash)
perforating variant (crusted or ulcerated lesion)
subcutaneous variant (soft nodule)
patch variant (erythematous plaques)
Misha Rosenbach, MD
Dermatology and Internal Medicine
University of Pennsylvania
MR has received consulting fees from Merck, aTyr Pharma, and Processa Pharma, not related to granuloma annulare. He has received grant support from Processa Pharma, not related to granuloma annulare. MR has received salary support from the AMA/JAMA for his role at JAMA Dermatology as Deputy Editor. MR is an author of references cited in this topic.
Dr Misha Rosenbach would like to gratefully acknowledge Dr Susmita Mukherjee, a previous contributor to this topic. SM declares that she has no competing interests.
Aisha Sethi, MD
Assistant Professor of Medicine
Associate Residency Program Director
University of Chicago
AS declares that she has no competing interests.
Robert Herd, MSc, MD, FRCP
Department of Dermatology
RH declares that he has no competing interests.
Brenda L. Pellicane, MD
Wayne State University School of Medicine
Department of Dermatology
BLP declares that she has no competing interests.
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