Granuloma annulare is a common, benign skin condition that causes raised, ring-shaped bumps on the skin. While the condition is not contagious or harmful, it can be a cosmetic concern and sometimes persists for months or years. Understanding the triggers, symptoms, and treatment options can help you manage this condition effectively and restore clear, healthy skin.

What is Granuloma Annulare?

Granuloma annulare is a chronic inflammatory skin condition characterized by small, firm, flesh-colored or reddish bumps that form a ring-like pattern. These lesions are usually painless and non-itchy, but they can sometimes be tender to touch.

The exact cause of granuloma annulare is not fully understood, but it is believed to involve an immune system reaction that causes inflammation in the skin.

Who Gets Granuloma Annulare?

Granuloma annulare can affect people of all ages, but it is most common in:

• Children and young adults

• Individuals with certain underlying conditions, including diabetes or thyroid disorders

• Women, as they are slightly more likely to develop the condition than men

Types of Granuloma Annulare

There are several types of granuloma annulare, each with unique characteristics:

1. Localized Granuloma Annulare

• The most common form.

• Causes one or more ring-shaped patches, usually on the hands, feet, elbows, or knees.

2. Generalized Granuloma Annulare

• More widespread, with numerous rings or bumps across the trunk, arms, and legs.

• More common in adults.

3. Subcutaneous Granuloma Annulare

• Causes firm, painless lumps under the skin.

• Seen mostly in children, often on the scalp, hands, or shins.

4. Perforating Granuloma Annulare

• Rare form that causes bumps with a central crust or ulceration.

• Can sometimes leave scars after healing.

Causes and Risk Factors

While the exact cause is unknown, several factors may play a role:

• Immune system response – inflammation triggered by unknown causes.

• Minor skin injuries – such as insect bites, scratches, or sun exposure.

• Systemic conditions – diabetes, thyroid disease, or other metabolic disorders.

• Certain medications – such as allopurinol or TNF-alpha inhibitors.

• Viral infections – in some cases, granuloma annulare appears after illness.

Symptoms of Granuloma Annulare

Typical signs include:

• Ring-shaped or circular patches of bumps.

• Lesions that are flesh-colored, pink, red, or purple.

• Lesions may slowly enlarge over time, forming a well-defined border.

• Usually no pain or itching, but some patients report mild discomfort.

Unlike other rashes, granuloma annulare does not cause scaling or oozing.

Diagnosis

A dermatology provider can often diagnose granuloma annulare by visually examining the affected skin. If the appearance is unclear, a skin biopsy may be performed to confirm the diagnosis under a microscope. This helps rule out other conditions such as:

• Tinea corporis (ringworm)

• Erythema annulare centrifugum

• Sarcoidosis

• Necrobiosis lipoidica

Treatment Options for Granuloma Annulare

Granuloma annulare is often self-limited and may resolve on its own within 6–24 months. However, treatment may be recommended for persistent, widespread, or cosmetically bothersome cases.

1. Topical Corticosteroids

• Applied directly to the affected area to reduce inflammation.

• May be combined with occlusion (covering with a bandage) for better absorption.

2. Intralesional Steroid Injections

• Injected directly into lesions for faster resolution.

• Useful for localized, thick plaques.

3. Cryotherapy

• Freezing lesions with liquid nitrogen may help flatten them.

4. Phototherapy (Light Therapy)

• Narrowband UVB or PUVA therapy can be used for widespread granuloma annulare.

5. Systemic Medications

• In resistant or generalized cases, oral medications such as hydroxychloroquine, isotretinoin, or dapsone may be prescribed.

Your dermatology provider will choose the most appropriate treatment based on the severity and location of lesions.

Prognosis and Long-Term Outlook

Most cases of granuloma annulare eventually resolve on their own without leaving scars, though discoloration may remain temporarily. Recurrence is possible but not harmful.

When to See a Dermatology Provider

Seek evaluation if:

• The rash spreads quickly or covers a large area.

• Lesions are painful, ulcerated, or appear infected.

• You are concerned about the cosmetic appearance.

• You have underlying health conditions such as diabetes and develop new or unusual skin lesions.

At My Skin St. Pete and My Skin Bradenton, Leah Michel, APRN, FNP-BC, provides expert diagnosis and treatment options to help manage granuloma annulare and restore confidence in your skin’s appearance.

Final Thoughts

Granuloma annulare is a harmless but sometimes persistent skin condition. With proper evaluation, you can confirm the diagnosis, rule out more serious conditions, and choose the best treatment to speed up healing. Many patients benefit from simple topical therapies or even just reassurance that the condition is benign.

Disclaimer:
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