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Diseases and Conditions
Granuloma annulare
From MayoClinic.com
Special to CNN.com

Introduction

Granuloma annulare is a chronic skin condition consisting of raised, reddish or skin-colored bumps (lesions) that form ring patterns, usually on your hands and feet.

Granuloma annulare occurs most often in children and young adults, though it can affect people of all ages. Although the lesions may be unsightly, granuloma annulare usually causes no other signs or symptoms. The cause of granuloma annulare isn't known.

Treatment for granuloma annulare isn't necessary in most cases because the lesions usually disappear on their own within two years. If you prefer treatment for cosmetic reasons, your doctor may prescribe corticosteroids to improve the appearance of the lesions and speed their disappearance.

Signs and symptoms

Granuloma annulare is generally marked by:

  • Reddish or skin-colored bumps (lesions) that expand or join to form ring patterns, most commonly on your hands and feet. The patterns may resemble ringworm.
  • Mild itching in some people, though the lesions usually cause no pain or itching.

Although the lesions may be unsightly, granuloma annulare usually causes no other signs or symptoms. The lesions may disappear and reappear at a later time.

A more severe, widespread form of this condition is called generalized granuloma annulare. In generalized granuloma annulare, rings appear over much of your body, lesions are often smaller and itching is more common.

Causes

The cause of granuloma annulare is unknown.

Granuloma annulare is occasionally associated with diabetes, thyroid disease and HIV infection, but most people with granuloma annulare are otherwise healthy.

Risk factors

Women are twice as likely to have granuloma annulare as men are. Young adults and children are most at risk.

There is some evidence that granuloma annulare is more common in people with diabetes, thyroid disease or HIV. Experts don't know the reason for this association.

When to seek medical advice

Call your doctor if your skin develops reddish bumps (lesions) in ring patterns that don't go away within a few weeks.

Screening and diagnosis

In many cases, your doctor can diagnose granuloma annulare by examining the affected skin.

To rule out a fungal infection, your doctor may recommend a procedure called a KOH test. In this test, your doctor scrapes your skin with a glass slide to collect dead skin cells. The skin cells are mixed with potassium hydroxide (KOH) and viewed under a microscope to help single out a fungal infection.

To confirm a diagnosis of granuloma annulare, your doctor may recommend a skin biopsy. In this test, a small sample of the affected skin is removed. The skin sample is examined under a microscope to confirm a diagnosis of granuloma annulare.

Treatment

In most cases, no treatment is necessary for granuloma annulare. Most lesions disappear on their own within a few months to two years.

If the appearance of the rash bothers you, your doctor can recommend a treatment plan. This may include:

  • Corticosteroid creams or ointments. Your doctor may prescribe corticosteroid topical creams, such as clobetasol propionate (Temovate, others), to help speed the disappearance and improve the appearance of the lesions. Depending on the thickness of the lesions and the strength of the cream, your doctor may direct you to cover the cream with bandages or an adhesive patch. This is because covering the steroid cream makes it more potent.
  • Corticosteroid injections. If the skin lesions are thicker and your symptoms are greater, your doctor may inject corticosteroids (triamcinolone, others) directly into the affected skin to help the lesions disappear faster.
  • Freezing the lesions (cryotherapy). In cryotherapy, your doctor applies liquid nitrogen to the affected area with a cotton-tipped applicator or a small instrument designed for applying extreme cold (a spray device or a cryoprobe). The procedure usually lasts from just a few seconds to one minute. The liquid nitrogen freezes the lesions, helping to remove them and stimulate new growth of cells in your skin.

Light therapy
In severe cases of generalized granuloma annulare, your doctor may recommend a special kind of ultraviolet light therapy called psoralen plus ultraviolet A (PUVA). This treatment combines exposure to ultraviolet light (phototherapy) with drugs that help make your skin more receptive to the effects of ultraviolet light (psoralens).

Another type of ultraviolet light therapy for treatment of granuloma annulare, narrowband ultraviolet B (UVB) phototherapy, is under study. However, more research is needed.

July 28, 2006

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