Granuloma Annulare – Causes, Symptoms, Treatment, Types, Pictures

Granuloma Annulare – Causes, Symptoms, Treatment, Types, Pictures






Granuloma annulare is a skin disorder that caused raised lesions on the hands and feet. It is a rare skin condition causing Itchy Skin. What exactly triggers this condition is not known, but often the lesions are harmless and disappear without wanting any treatment. GA can occur in any age group and sex and is categorized under dermatosis.

Granuloma Annulare Types :

There are 4 types of granuloma annulare (GA) differing in the aspect of size and the site it occurs on the body.

Localized – This form causes skin or flesh colored lesions that measure roughly 5cm in diameter. It exists in the form of distinct ring like pattern on the upper surface of the skin or epidermis. Localized GA is often seen on the wrists, lower limbs, ankles and the feet like annular rings with raised papules in it.

Generalized – This kind of GA occurs in adults commonly. It can occur anywhere in the body as the name suggests, but is often marked to extremities (hands and feet), face and neck. The lesions appear as annular plaques showing variations in color from pink to violet.

Subcutaneous GA – This kind commonly occurs in children in the form of firm, raised nodules in the deep dermis region. The size of each lesion may range from 5mm to 4cm in circumference and is largely seen on the areas of hands, feet, ankles, buttocks, eyelids and even on the head.

Perforating GA – It is a rare kind of GA restricting to hands and fingers causing raised bumps oozing out fluid and leaves a scar after healing.

Symptoms :

• Symptoms of GA vary as per the type and the site of infection.


• The bumps or lesions are round shaped with raised defined patches seen on the feet and hands of the affected person. In some children it can occur on the ankles and wrists.


• Generalized GA can be itchy and painful which occurs largely on the arms, legs and trunk.


• Subcutaneous GA occurs under the skin of young children and spreads like that of a rash. Here the lesions are smaller in size and it can be itchy.


• The color of the lesions may range from skin color to orange and dark pink.

Causes of Granuloma Annulare :

What triggers lesion due to GA is not known. It can be caused by many factors that act as triggering agents. Lesions can occur after skin infections, insect bites, and excess of exposure to sun and due to Allergy caused by vaccination. TB skin test can also trigger this reaction. Several kinds of viral infection can also cause papules or lesions on the skin. Granuloma annulare do not spread to others by touching.

Risk Factors :

• Anyone can develop GA but people with weakened immunity and with chronic diseases are more prone than others.


• Individuals with Type 1 Diabetes, HIV infection, Hodgkin Lymphoma and other types of Cancer are at increased risk of developing GA.


• People with history of viral infections like hepatitis infection and Thyroid problems can get GA.


• When compared with men, women are at increased risk for GA.


• Children are more prone to develop localized GA and are also commonly seen in adults below 30 years. Aged people are at risk of developing generalized form.

Diagnosis :

The doctor can detect GA by examining the affected skin. Biopsy (small tissue sample) can be done and examined in the lab settings to confirm the diagnosis.

Treatment :

• Often GA does not require any medical treatment, since the lesions resolve after few weeks or months.


• For severe cases of lesions with itchiness and pain, medications are available.


• Topical creams that contain steroid are recommended to improve the symptoms. Cream is liberally applied on the lesions or bumps and covered with bandages. Within few days the lesions would disappear from the skin.


• Corticosteroids cream like clobetasol, Triamcinolone and Prednisone ointment are largely prescribed.


• Retinoids like Accutane or Isotretinoin are given for treating severe form of GA. In some cases psoralen phototherapy agents like methoxsalen plus are suggested.


• In rare cases corticosteroid injection is given directly in the lesions to get quick results. Some doctors use cryotherapy method in which liquid nitrogen is used on the lesions for removing them permanently.


• Phototherapy can also be done by passing specific beam of light directly into the lesions. Supplementary oral pills are also given for the patients if the lesions are widespread.


• Laser therapy is also used for treating lesions in the localized and generalized form of GA.

Outlook :

Prognosis of GA differs in every person. There are cases wherein the lesions have disappeared within weeks and some cases where treatment is taken for months together. There is a 40% chance of recurrence of lesions. When comparing with localized form, generalized granuloma is difficult to treat since the response is very poor and it takes long term for complete healing.

Granuloma Annulare

Granuloma Annulare






Granuloma annulare is a chronic skin rash with features of red lesions formed on the skin in the form of ring. There are several types of GA and localized granuloma is very common. Lesions may grow up to 5cm in diameter with firm nodules and is largely seen on ankles, feet, limbs and wrists. Generalized granuloma occurs only in adults and it affects neck, face, palms and even scalp. Subcutaneous granuloma is more prevalent in children and prdouces nodules without symptoms in hands, buttocks and eyelids. Perforating granuloma is very rare and is limited to hands and fingers.

Causes :

The exact cause of granuloma is not known. However it affects healthy as well as sick individuals. People having diabetics and thyroid problem are more prone to GA than others.

Symptoms :

Except for lesions (reddish brown color) no other visible symptoms are observed in GA. For some people it may cause itching but will not cause pain. Ring like structures are found in hands, fingers and other infected parts of the body. Very rarely these lesions may spread to other parts. Lesions, in general get healed soon in winter and it worsens in summer months. The part in which lesions develop varies widely with the type of GA you have got. In case of generalized GA, it may grow up to 3-6 cm in diameter and affects your hands, soles and palms.

Any type of GA increases in numbers when exposed to powerful sunrays and hence it is wise to stay away from sunlight.

Granuloma with systemic diseases

Granuloma is associated with diabetics (Type 1) and also on patients with history of AIDS and herpes zoster. Still there is no supporting evidence to establish the association with systemic diseases. Again people with Hodgkin lymphoma and Non Hodgkin lymphoma are prone to get GA.

Diagnoses :

An expert doctor can identify the disorder on physical examination of the affected part. In some cases, he may ask you to take KOH test for differentiating Granuloma from ordinary fungal infection.

Pictures of Granuloma Annulare :

Images, Pics, Pictures and Photos of Granuloma Annulare

Treatment :

Since GA does not cause any problem to the affected person, it requires no treatment. You can apply steroid ointments to remove rashes on the parts of the body. Sometimes, if the rings are very intense, your doctor may give you a steroid shot directly on the affected part. They also use liquid nitrogen for electrocuting the bumps on the skin. Granuloma poses problem for cosmetic reasons and hence you need not visit the doctor urgently for taking treatment.

Oral medications and other forms of therapy are also available for clearing off lesions. Lesions can be successfully treated with cyclosporine, hydroxychloroquine, potassium iodide and dapsone. Most of the severe forms of lesions can be controlled using cryotherapy and by application of corticosteroids. Clobetasol ointment, Triamcinolone acetonide and Prednisone is effective in suppressing the lesions due to its anti-inflammatory property.

Granuloma Annulare – Treatment, Symptoms, Causes, Pictures, Cure

Granuloma Annulare – Treatment, Symptoms, Causes, Pictures, Cure

What is Granuloma Annulare?

This is a skin condition that is chronic and consists of raised, skin-colored or reddish bumps or lesions that develop ring patterns, normally on the hands, elbows, knees and feet.

These lesions can be very unsightly, but normally cause no additional symptoms and don’t have any lasting influence on an individual’s health. But, granuloma annulare is hard to deal with if the lesions affect the appearance.

In the majority of cases these lesions vanish on their own in 1 to 2 years. If an individual chooses treatment for cosmetic aims, your physician can prescribe corticosteroids which improve the looks of the bumps or lesions as well as speed disappearance of the condition.

Granuloma Annulare Symptoms

Granuloma annulare is normally marked by:

• Reddish, skin-colored and raised bump or lesions that can grow or can link to form patterns of a ring and are most common on the feet or hands. These patterns can resemble ringworm.


• Itching that is mild – This occurs in some individuals, however the lesions normally cause little to no itching or pain.

The lesions can be unsightly, but granuloma annulare normally causes no other symptoms or signs. The lesion can disappear and then recur at a future time.

An additional widespread and severe form of this disorder is known as “generalized granuloma annulare”. With this type of the disease, the rings develop over most of the body, lesions are frequently reduced and itching is very common.

An individual should call their primary care physician if the skin has reddish bump or lesions in ring shapes and do not go away in several weeks.

Granuloma Annulare Causes

The source of this skin condition is not known. Granuloma annulare is on occasion linked with diabetes mellitus as well as other diseases, but most often when the lesions or bumps are numerous or more generalized. The majority of individuals with granuloma annulare are usually healthy otherwise.

Though this condition can affect individuals of any sex or any age group, there are some generalities. Risk aspects include:

• Being female – women are 2x as likely to have this condition


• Being a young adult or child

You are at a much greater risk of having generalized or widespread granuloma annulare if:

• Over the age of 40


• Have diabetes mellitus or diseases of the thyroid, but medical professionals do not know the reason for these associations.

Granuloma Annulare Treatment

In the majority of cases, the primary care physician can diagnose this condition by merely examining the skin that is affected. In order to confirm a case of granuloma annulare or to rule out other skin problems, these tests can be recommended:

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Skin biopsy
With this test, a small portion of the affected skin is removed. This sample is examined under a microscope by a specialist to confirm the diagnosis.

KOH test
The doctor scrapes the skin with a glass slide to gather some dead cells of skin. This sample is mixed with potassium hydroxide or KOH and examined under a microscope to aid in deciding if it could be an infection caused by fungus.

In the majority of cases, treatment is not needed for granuloma annulare. Most of the lesions will disappear within several months to a couple of years.

If the look of the rash bothers the individual, the doctor can endorse a treatment plan. This plan can include:

Corticosteroid ointments or creams
These medications may help to recover the appearance of the bumps or lesions as well as speed up their vanishing. Contingent on the lesion thickness and the cream strength, the doctor may advise you to protect the cream with adhesive patches or bandages. Covering any steroid cream can make it more effective.

Lesion freezing or cryotherapy
With cryotherapy, the physician applies nitrogen liquid to the areas which are affected using an applicator that is cotton-tipped or a tiny instrument intended for applying extreme cold – a device that sprays or a cryoprobe. This process normally lasts from only several seconds to 1 minute. The nitrogen liquid freezes these lesions, which AIDS to eliminate them as well as encourage new growth of cells in the skin.

Corticosteroid injections
If the skin bumps or lesions are thicker and the symptoms greater, the physician can inject corticosteroids – triamcinolone – directly into the skin that is affected to aid the lesions to disappear quicker.

Light therapy

With severe cases of “generalized granuloma annulare”, the physician can endorse a distinctive type of ultraviolet light treatment known as “psoralen plus ultraviolet A” – PUVA. This therapy associates the experience of ultraviolet light – phototherapy, with drugs referred to as psoralens. This helps make the skin more amenable to properties of the ultraviolet light.

Granuloma Annulare Cure

This skin disease will eventually disappear but it can become a chronic condition. Since granuloma annulare normally develops on the sun-exposed areas of the forearms or hands, protecting these areas from sun by limiting the exposure, cover with appropriate clothing or applying a high-quality sunscreen can also help.

Granuloma Annulare Pictures

on hands