Not to be confused with Granuloma inguinale. Granuloma annulare Perforating form of Granuloma annulare on hand Specialty| Dermatology Symptoms| Clusters of reddish bumps arranged in a circle with a dusky centre and rolled edge, on backs of hands and feet.[1] Usual onset| Children, young adults[1] Causes| Unknown[1] Treatment| Topical corticosteroid[1] Frequency| Females>males[2] Granuloma annulare is an inflammation of skin that generally presents as a cluster of small reddish bumps arranged in a circle or ring, typically on the backs of hands and feet.[1] The edge may appear rolled, the centre dusky, and scale is absent.[3] It has been associated with diabetes and thyroid disease, but the cause is unknown.[1] Treatment usually involves applying topical corticosteroid.[1] It is more common in children and young adults.[1] Females are affected more frequently than males.[2] ## Contents * 1 Signs and symptoms * 2 Causes * 3 Pathology * 4 Diagnosis * 4.1 Types * 5 Treatment * 6 History * 7 See also * 8 References * 9 External links ## Signs and symptoms[edit | edit source] Aside from the visible rash, granuloma annulare is usually asymptomatic. Sometimes the rash may burn or itch. People with granuloma annulare usually notice a ring of small, firm bumps (papules) over the backs of the forearms, hands or feet, often centered on joints or knuckles. The bumps are caused by the clustering of T cells below the skin. These papules start as very small, pimple looking bumps, which spread over time from that size to dime, quarter, half-dollar size and beyond. Occasionally, multiple rings may join into one. Rarely, granuloma annulare may appear as a firm nodule under the skin of the arms or legs. It also occurs on the sides and circumferential at the waist and without therapy can continue to be present for many years. Outbreaks continue to develop at the edges of the aging rings.[citation needed] * Granuloma annulare * Granuloma annulare * Granuloma annulare * Granuloma annulare ## Causes[edit | edit source] The condition is usually seen in otherwise healthy people. Occasionally, it may be associated with diabetes or thyroid disease. It has also been associated with auto-immune diseases such as systemic lupus erythematosus, rheumatoid arthritis, Lyme disease and Addison's disease. At this time, no conclusive connection has been made between patients.[citation needed] ## Pathology[edit | edit source] Micrograph showing a palisaded granuloma in a case of granuloma annulare. H&E stain. Granuloma annulare microscopically consists of dermal epithelioid histiocytes around a central zone of mucin—a so-called palisaded granuloma.[citation needed] ## Diagnosis[edit | edit source] ### Types[edit | edit source] Granuloma annulare may be divided into the following types:[4]: 703–5 * Localized granuloma annulare * Generalized granuloma annulare * Patch-type granuloma annulare * Subcutaneous granuloma annulare * Perforating granuloma annulare ## Treatment[edit | edit source] Because granuloma annulare is usually asymptomatic and self-limiting with a course of about 2 years, initial treatment is generally topical steroids or calcineurin inhibitors; if unimproved with topical treatments, it may be treated with intradermal injections of steroids. If local treatment fails it may be treated with systemic corticosteroids.[5][6] Treatment success varies widely, with most patients finding only brief success with the above-mentioned treatments. New research out of India suggests that the combination of rifampin (600 mg), ofloxacin (400 mg), and minocycline hydrochloride (100 mg) once monthly, or ROM therapy, produces promising results.[7] Most lesions of granuloma annulare disappear in pre-pubertal patients with no treatment within two years while older patients (50+) have rings for upwards of 20 years. The appearance of new rings years later is not uncommon.[8] ## History[edit | edit source] The disease was first described in 1895 by Thomas Colcott Fox and it was named granuloma annulare by Henry Radcliffe Crocker in 1902.[9] ## See also[edit | edit source] * Granuloma * Necrobiosis lipoidica ## References[edit | edit source] 1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Wakelin, Sarah H. (2020). "22. Dermatology". In Feather, Adam; Randall, David; Waterhouse, Mona (eds.). Kumar and Clark's Clinical Medicine (10th ed.). Elsevier. p. 667\. ISBN 978-0-7020-7870-5. Archived from the original on 2021-12-11. Retrieved 2021-12-11. 2. ↑ 2.0 2.1 "Granuloma annulare | DermNet". dermnetnz.org. Archived from the original on 3 December 2022. Retrieved 29 March 2023. 3. ↑ Dennis, Mark; Bowen, William Talbot; Cho, Lucy (2012). "Granuloma annulare". Mechanisms of Clinical Signs. Elsevier. p. 525\. ISBN 978-0729540759. Archived from the original on 2021-07-14. Retrieved 2016-10-18; pbk`{{cite book}}`: CS1 maint: postscript (link) 4. ↑ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. 5. ↑ "Archive copy". Archived from the original on 2013-10-17. Retrieved 2013-06-14.`{{cite web}}`: CS1 maint: archived copy as title (link) 6. ↑ "Archive copy". Archived from the original on 2019-08-04. Retrieved 2019-08-04.`{{cite web}}`: CS1 maint: archived copy as title (link) 7. ↑ Marcus, D. V.; Mahmoud, B. H.; Hamzavi, I. H. (2009). "Granuloma annulare treated with rifampin, ofloxacin, and minocycline combination therapy". Archives of Dermatology. 145 (7): 787–9. doi:10.1001/archdermatol.2009.55. PMID 19620560. 8. ↑ "Granuloma Annulare: Treatment & Medication - March 14, 2007". Archived from the original on September 16, 2017. Retrieved July 12, 2009. 9. ↑ Shanmuga1, Sekar C.; Rai1, Reena; Laila1, A.; Shanthakumari, S.; Sandhya, V. (2010), "Generalized granuloma annulare with tuberculoid granulomas: A rare histopathological variant", Indian Journal of Dermatology, Venereology and Leprology, 76 (1): 73–75, doi:10.4103/0378-6323.58691, PMID 20061743, archived from the original on 4 September 2019, retrieved 23 May 2010 ## External links[edit | edit source] Classification| * ICD-10: L92.0 * ICD-9-CM: 695.89 * MeSH: D016460 * DiseasesDB: 5414 | External resources| * MedlinePlus: 000833 * eMedicine: derm/169 * v * t * e Diseases of the skin and appendages by morphology Growths| | Epidermal| * Wart * Callus * Seborrheic keratosis * Acrochordon * Molluscum contagiosum * Actinic keratosis * Squamous-cell carcinoma * Basal-cell carcinoma * Merkel-cell carcinoma * Nevus sebaceous * Trichoepithelioma | Pigmented| * Freckles * Lentigo * Melasma * Nevus * Melanoma Dermal and subcutaneous| * Epidermal inclusion cyst * Hemangioma * Dermatofibroma (benign fibrous histiocytoma) * Keloid * Lipoma * Neurofibroma * Xanthoma * Kaposi's sarcoma * Infantile digital fibromatosis * Granular cell tumor * Leiomyoma * Lymphangioma circumscriptum * Myxoid cyst Rashes| | With epidermal involvement| | Eczematous| * Contact dermatitis * Atopic dermatitis * Seborrheic dermatitis * Stasis dermatitis * Lichen simplex chronicus * Darier's disease * Glucagonoma syndrome * Langerhans cell histiocytosis * Lichen sclerosus * Pemphigus foliaceus * Wiskott–Aldrich syndrome * Zinc deficiency | Scaling| * Psoriasis * Tinea (Corporis * Cruris * Pedis * Manuum * Faciei) * Pityriasis rosea * Secondary syphilis * Mycosis fungoides * Systemic lupus erythematosus * Pityriasis rubra pilaris * Parapsoriasis * Ichthyosis Blistering| * Herpes simplex * Herpes zoster * Varicella * Bullous impetigo * Acute contact dermatitis * Pemphigus vulgaris * Bullous pemphigoid * Dermatitis herpetiformis * Porphyria cutanea tarda * Epidermolysis bullosa simplex Papular| * Scabies * Insect bite reactions * Lichen planus * Miliaria * Keratosis pilaris * Lichen spinulosus * Transient acantholytic dermatosis * Lichen nitidus * Pityriasis lichenoides et varioliformis acuta Pustular| * Acne vulgaris * Acne rosacea * Folliculitis * Impetigo * Candidiasis * Gonococcemia * Dermatophyte * Coccidioidomycosis * Subcorneal pustular dermatosis Hypopigmented| * Tinea versicolor * Vitiligo * Pityriasis alba * Postinflammatory hyperpigmentation * Tuberous sclerosis * Idiopathic guttate hypomelanosis * Leprosy * Hypopigmented mycosis fungoides Without epidermal involvement| | Red| | Blanchable Erythema| | Generalized| * Drug eruptions * Viral exanthems * Toxic erythema * Systemic lupus erythematosus | Localized| * Cellulitis * Abscess * Boil * Erythema nodosum * Carcinoid syndrome * Fixed drug eruption Specialized| * Urticaria * Erythema (Multiforme * Migrans * Gyratum repens * Annulare centrifugum * Ab igne) Nonblanchable Purpura| | Macular| * Thrombocytopenic purpura * Actinic/solar purpura | Papular| * Disseminated intravascular coagulation * Vasculitis Indurated| * Scleroderma/morphea * Granuloma annulare * Lichen sclerosis et atrophicus * Necrobiosis lipoidica Miscellaneous disorders| | Ulcers| | Hair| * Telogen effluvium * Androgenic alopecia * Alopecia areata * Systemic lupus erythematosus * Tinea capitis * Loose anagen syndrome * Lichen planopilaris * Folliculitis decalvans * Acne keloidalis nuchae Nail| * Onychomycosis * Psoriasis * Paronychia * Ingrown nail Mucous membrane| * Aphthous stomatitis * Oral candidiasis * Lichen planus * Leukoplakia * Pemphigus vulgaris * Mucous membrane pemphigoid * Cicatricial pemphigoid * Herpesvirus * Coxsackievirus * Syphilis * Systemic histoplasmosis * Squamous-cell carcinoma * v * t * e Cutaneous keratosis, ulcer, atrophy, and necrobiosis Epidermal thickening| * keratoderma: Keratoderma climactericum * Paraneoplastic keratoderma * Acrokeratosis paraneoplastica of Bazex * Aquagenic keratoderma * Drug-induced keratoderma * psoriasis * Keratoderma blennorrhagicum * keratosis: Seborrheic keratosis * Clonal seborrheic keratosis * Common seborrheic keratosis * Irritated seborrheic keratosis * Seborrheic keratosis with squamous atypia * Reticulated seborrheic keratosis * Dermatosis papulosa nigra * Keratosis punctata of the palmar creases * other hyperkeratosis: Acanthosis nigricans * Confluent and reticulated papillomatosis * Callus * Ichthyosis acquisita * Arsenical keratosis * Chronic scar keratosis * Hyperkeratosis lenticularis perstans * Hydrocarbon keratosis * Hyperkeratosis of the nipple and areola * Inverted follicular keratosis * Lichenoid keratosis * Multiple minute digitate hyperkeratosis * PUVA keratosis * Reactional keratosis * Stucco keratosis * Thermal keratosis * Viral keratosis * Warty dyskeratoma * Waxy keratosis of childhood * other hypertrophy: Keloid * Hypertrophic scar * Cutis verticis gyrata Necrobiosis/granuloma| | Necrobiotic/palisading| * Granuloma annulare * Perforating * Generalized * Subcutaneous * Granuloma annulare in HIV disease * Localized granuloma annulare * Patch-type granuloma annulare * Necrobiosis lipoidica * Annular elastolytic giant-cell granuloma * Granuloma multiforme * Necrobiotic xanthogranuloma * Palisaded neutrophilic and granulomatous dermatitis * Rheumatoid nodulosis * Interstitial granulomatous dermatitis/Interstitial granulomatous drug reaction | Foreign body granuloma| * Beryllium granuloma * Mercury granuloma * Silica granuloma * Silicone granuloma * Zirconium granuloma * Soot tattoo * Tattoo * Carbon stain Other/ungrouped| * eosinophilic dermatosis * Granuloma faciale Dermis/ localized CTD| | Cutaneous lupus erythematosus| * chronic: Discoid * Panniculitis * subacute: Neonatal * ungrouped: Chilblain * Lupus erythematosus–lichen planus overlap syndrome * Tumid * Verrucous * Rowell's syndrome | Scleroderma/ Morphea| * Localized scleroderma * Localized morphea * Morphea–lichen sclerosus et atrophicus overlap * Generalized morphea * Atrophoderma of Pasini and Pierini * Pansclerotic morphea * Morphea profunda * Linear scleroderma Atrophic/ atrophoderma| * Lichen sclerosus * Anetoderma * Schweninger–Buzzi anetoderma * Jadassohn–Pellizzari anetoderma * Atrophoderma of Pasini and Pierini * Acrodermatitis chronica atrophicans * Semicircular lipoatrophy * Follicular atrophoderma * Linear atrophoderma of Moulin Perforating| * Kyrle disease * Reactive perforating collagenosis * Elastosis perforans serpiginosa * Perforating folliculitis * Acquired perforating dermatosis Skin ulcer| * Pyoderma gangrenosum Other| * Calcinosis cutis * Sclerodactyly * Poikiloderma vasculare atrophicans * Ainhum/Pseudo-ainhum *[v]: View this template *[t]: Discuss this template *[e]: Edit this template