Granuloma annulare is a benign, chronic, idiopathic condition characterized by papules or nodules that expand peripherally to form a ring around normal or slightly depressed skin. Diagnosis is by clinical evaluation and sometimes biopsy. Treatment is with topical or intralesional corticosteroids, topical tacrolimus, cryotherapy, and phototherapy.
Etiology of Granuloma Annulare
Etiology of granuloma annulare is unclear, but proposed mechanisms include cell-mediated immunity (type IV), immune complex vasculitis, and an abnormality of tissue monocytes. Many diseases, infections, medications, and environmental factors have been reported in patients with granuloma annulare, but any associations are still unclear. The condition is twice as prevalent among women.
Symptoms and Signs of Granuloma Annulare
Lesions are erythematous, yellowish tan, bluish, or the color of the surrounding skin; one or more lesions may occur, most often on dorsal feet, legs, hands, or fingers. They are usually asymptomatic but may occasionally be tender. The lesions often expand or join to form rings. The center of each ring may be clear or be slightly depressed and sometimes pale or light brown. In some cases, lesions may become generalized and widespread. Lesions may appear hypopigmented on dark skin.
Photo courtesy of Karen McKoy, MD.
Diagnosis of Granuloma Annulare
Clinical evaluation
Sometimes biopsy
Diagnosis of granuloma annulare is usually clinical but can be confirmed by skin biopsy.
Unlike tinea corporis (which can cause raised annular lesions with central clearing), granuloma annulare typically has no scale and does not itch.
Treatment of Granuloma Annulare
For localized lesions, sometimes potent topical or intralesional corticosteroids, topical tacrolimus, cryotherapy, and/or phototherapy
For widespread lesions, sometimes hydroxychloroquine, isotretinoin, dapsone, and/or cyclosporine
Usually no treatment is necessary; spontaneous resolution is common but may take years. For patients with more widespread or bothersome lesions, quicker resolution may be desired.
For localized lesions, high-strength topical or intralesional corticosteroids, topical tacrolimus, cryotherapy, and various forms of phototherapy may be used.
For widespread lesions, hydroxychloroquine, isotretinoin, dapsone, and cyclosporine may be successful.
Tumor necrosis factor (TNF)-alpha inhibitor therapy has been reported to be effective in treating granuloma annulare but has also been reported as a potential inciting factor in some patients.
Ключові моменти
Diagnose granuloma annulare clinically (eg, by the characteristic rings with central clearing and absence of scaling).
If symptoms are bothersome, consider various topical or systemic medications, cryotherapy, or phototherapy.
