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Granuloma Annulare : Introduction


Granuloma annulare may be a 
common skin condition characterized by bumps appearing over the joints and therefore the backs of the hands. Its cause isn't known, and most episodes of granuloma annulare clear up after a couple of years, with or without treatment.

Who's at risk?

Although granuloma annulare can occur in people of any race and at any age, it's 
most ordinarily seen in children and young adults. Females are slightly more likely than males to develop granuloma annulare.

Signs and Symptoms

Granuloma annulare occurs most often 
over the joints or in areas that have mild injury. The most common locations for granuloma annulare include:


Ø  Backs of the hands and tops of the fingers

Ø  Tops of the feet

Ø  Around the elbows

Ø  Around the knees

The lesions of granuloma annulare are usually found within the 
same areas on each side of the body (symmetrically).

Granuloma annulare appears as small (1–3 mm), skin-colored or pink bumps. These bumps, which are smooth instead of scaly, may occur singly or in groups. Each bump may expand in size, leaving a shallow indentation within the center, which can be lighter or darker than your normal complexion . Alternatively, several small bumps may merge to make a hoop , 1–5 cm in diameter. Healed lesions of granuloma annulare don't leave scars.

Granuloma annulare doesn't usually have any symptoms, though some individuals may experience itching.

Rarely, granuloma annulare could also be widespread, called generalized granuloma annulare. Generalized granuloma annulare tends to seem in adults over 30 years old. The condition may contains hundreds to thousands of 1–2 mm bumps that appear on the arms, legs, and upper trunk. These skin-colored or pink bumps could also be quite itchy.

Self-Care Guidelines

Because granuloma annulare doesn't 
usually have symptoms, it's going to go unnoticed for several months. If, however, the lesions are itchy, an over-the-counter cortisone cream could also be helpful.

When to Seek Medical Care

If you have bumps or ring-shaped lesions on your skin for more than several weeks, it is probably a good idea to have them evaluated by a dermatologist or by another health care provider who can distinguish them from conditions such as ringworm, insect bites, or even Lyme disease.

Treatments Your Physician May Prescribe

If the diagnosis of granuloma annulare isn't 
obvious, the doctor might want to perform a skin biopsy. The procedure involves:


Ø      Numbing the skin with an injectable anesthetic.

Ø      Sampling a small piece of skin by using a flexible razor blade, a scalpel, or a tiny cookie cutter (called a "punch biopsy"). If a punch biopsy is taken, a stitch (suture) or two could also be placed and can got to be removed 6–14 days later.

Ø      Having the skin sample examined under the microscope by a specially trained physician (dermatopathologist).

Once the diagnosis of granuloma annulare is confirmed, you and your physician may plan to 
not treat it. Up to 70% of cases of granuloma annulare get away by themselves (spontaneous resolution) within 2 years, even without treatment. However, up to 40% of individuals may experience a return of the lesions (recurrence), usually at an equivalent site(s) of the first rash.

If the lesions of granuloma annulare are uncomfortable or unsightly, the physician may try one among the following:


Ø  A prescription-strength steroid or cortisone cream

Ø  Steroid injections directly into the lesions

Ø  Freezing with liquid nitrogen (cryotherapy)

Ø  Non-steroid topical anti-inflammatory creams such as tacrolimus or pimecrolimus

Ø  Treatment with carbon dioxide laser

Generalized granuloma annulare is more stubborn, with fewer cases of spontaneous resolution and more recurrences. In addition, more aggressive medications may be used:


Ø    Oral steroids, such as prednisone

Ø    Oral retinoids, such as isotretinoin

Ø    Ultraviolet light

Ø    Other oral medications such as potassium iodide, dapsone, nicotinamide, pentoxifylline, hydroxychloroquine, or cyclosporine



Notice: Please consult your doctor before following any instruction of


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