Granuloma annulare

Last reviewed: 23 Apr 2022
Last updated: 26 Nov 2020

Summary

Definition

History and exam

Key diagnostic factors

  • asymptomatic grouped annular pink or flesh-colored dermal papules
More key diagnostic factors

Other diagnostic factors

  • flesh-colored, pink, or brown macules or small papules
  • soft-tissue nodules
  • perforating papules, crusting or ulcerated lesions
  • erythematous patches
Other diagnostic factors

Risk factors

  • diabetes mellitus
  • hematologic malignancy
  • herpes zoster
  • HIV
  • hepatitis
  • hyperlipidemia
  • thyroid disease
  • medications
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • skin biopsy
  • fasting blood sugar
  • thyroid function tests
  • lipid screening
  • hepatitis screen
  • HIV testing
More investigations to consider

Treatment algorithm

ACUTE

localized variant (classic annular rash)

generalized variant (widespread macular rash)

perforating variant (crusted or ulcerated lesion)

subcutaneous variant (soft nodule)

patch variant (erythematous plaques)

Contributors

Authors

Misha Rosenbach, MD

Associate Professor

Dermatology and Internal Medicine

University of Pennsylvania

Philadelphia

PA

Disclosures

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.

Acknowledgements

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.

Peer reviewers

Aisha Sethi, MD

Assistant Professor of Medicine

Associate Residency Program Director

University of Chicago

Chicago

IL

Disclosures

AS declares that she has no competing interests.

Robert Herd, MSc, MD, FRCP

Consultant Dermatologist

Department of Dermatology

Nuffield Hospital

Glasgow

UK

Disclosures

RH declares that he has no competing interests.

Brenda L. Pellicane, MD

Dermatologist

Wayne State University School of Medicine

Department of Dermatology

Detroit

MI

Disclosures

BLP declares that she has no competing interests.

Use of this content is subject to our disclaimer