Granuloma annulare

Date Updated: 07/13/2021

Overview

Granuloma annulare (gran-u-LOW-muh an-u-LAR-e) is a skin condition that causes a raised rash or bumps (lesions) in a ring pattern. The most common type affects young adults and usually affects the hands and feet.

Minor skin injuries and some drugs might trigger the condition. It's not contagious and usually not painful, but it can make you feel self-conscious. And if it becomes a long-term (chronic) condition, it can cause emotional distress.

Treatment might clear the skin gradually, but the lesions tend to come back. Untreated, the condition might last from a few weeks to decades.

Symptoms

The signs and symptoms of granuloma annulare can vary, depending on the type:

Localized. This is the most common type of granuloma annulare. The bump (lesion) borders are circular or semicircular, with a diameter up to 2 inches (5 centimeters). The lesions occur most commonly on the hands, feet, wrists and ankles of young adults.
Generalized. This type is uncommon and usually affects adults. It causes bumps that form a rash on most of the body, including the trunk, arms and legs. The rash might cause discomfort or itchiness.
Under the skin. A type that usually affects young children is called subcutaneous granuloma annulare. It produces small, firm lumps under the skin, instead of a rash. The lumps form on the hands, shins and scalp.

When to see a doctor

Call your doctor if you develop a rash or bumps (lesions) in ring pattern that don't go away within a few weeks.

Causes

It's not clear what causes granuloma annulare. Sometimes it's triggered by:

Animal or insect bites
Infections, such as hepatitis
Tuberculin skin tests
Vaccinations
Sun exposure
Minor skin injuries
Drugs

Granuloma annulare is not contagious.

Risk factors

Granuloma annulare is occasionally associated with diabetes or thyroid disease, most often when lesions are numerous or widespread. It may, rarely, be related to cancer, especially in older people whose granuloma annulare is severe, doesn't respond to treatment or returns after cancer treatment.

Diagnosis

Your doctor may diagnose granuloma annulare by examining the affected skin and taking a small skin sample (biopsy) to examine under a microscope.

Treatment

Granuloma annulare can clear on its own over time. Treatment might help clear the skin faster than if left untreated, but recurrence is common. The lesions that return after treatment tend to appear at the same spots, and 80% of those usually clear within two years.

Untreated, the lesions might last a few weeks or decades.

Treatment options include:

Corticosteroid creams or ointments. Prescription-strength products may help improve the appearance of the bumps and help them disappear faster. Your doctor may direct you to cover the cream with bandages or an adhesive patch, to increase the effectiveness of this treatment.
Corticosteroid injections. If the skin lesions aren't clearing up with topical treatment, your doctor may suggest a corticosteroid injection. Repeat injections may be needed every 6 to 8 weeks until the condition clears up.
Freezing. Applying liquid nitrogen to the affected area may help remove the lesions.
Light therapy. Exposing the lesions to certain types of light, including lasers, is sometimes helpful.
Oral medications. When the lesions are widespread, your doctor might prescribe drugs taken by mouth, such as antibiotics, antimalarials or drugs used to prevent immune system reactions.

Coping and support

These coping methods might help ease the distress of living with granuloma annulare long term:

Routinely reach out to friends and family members.
Join a local or reputable internet-based support group.

Preparing for an appointment

You're likely to start by seeing your primary care doctor. You may be referred to a specialist in skin conditions (dermatologist).

What you can do

Before your appointment, you might want to list answers to the following questions:

Have you recently traveled to a new area or spent significant time outdoors?
Do you have pets, or have you recently had contact with new animals?
Are any family members or friends having similar symptoms?
What medications or supplements do you take regularly?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

When did your skin condition first appear?
Does your rash cause any discomfort? Does it itch?
Have your symptoms become worse or stayed the same over time?
Have you been treating your skin condition with any medications or creams?
Does anything seem to improve — or worsen — your symptoms?
Do you have any other health conditions, such as diabetes or thyroid problems?