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Granuloma Annulare: Causes, Symptoms, Treatment, Recovery, Prognosis, Prevention, Risk Factors, Complications

What is Granuloma Annulare?

Granuloma annulare is a relatively common disease which takes place amongst people of all age groups. It is, however, rare in infancy. Granuloma annulare is a disease which has been characterized clinically by annular plaques and dermal papules. The exact cause is unknown. Histological examination has revealed that the foci of degenerative collagen have been linked with the palisaded granulomatous inflammation.

Granuloma annulare is also amongst the most common chronic skin condition that consists of one or more ring-shaped patches having purple or pink bumps or papules. It will also be able to affect bony areas such as the backs of hands, elbows or ankles. Granuloma annulare is also a common skin condition which has smooth discoloured plaques. They are annular or ring-shaped and thickened. We can also refer it to as necrobiotic papulosis.

What is Granuloma Annulare?

Who gets Granuloma Annulare?

Granuloma annulare is a disease which commonly affects the skin of children, teenagers or young adults (or older adults, less commonly)

Causes of Granuloma Annulare

There is no exact cause for this granuloma annulare. Some of the causes are Systemic Lupus, under-active thyroid, Cancer. Injury to skin, some allergy. It is more common in females as compared to males. It can occur at any one.

You should visit your doctor if there are reddish bumps (lesions) in ring patterns on your skin which are not going away within a few weeks.

Symptoms of Granuloma Annulare

A very common and major symptom includes reddish eruptions, bumpy skin rash, and circular rash with a little bit of itching. As a patient, you may see a ring of hard looking bumps over the back of the hands, forearms, and feet. At times the multiple rings may join into one.

Usually, no other causes are associated with granuloma annulare. However, the rash can be slightly itchy.

As a patient, you can see a ring of small yet firm bumps or papules as they are known over the backs of the hands, forearms, or feet. They may occasionally find a number of rings.

There are many rare cases in which the, granuloma annulare looks like a firm nodule under the skin of the arms or legs whereas in other cases rash spreads all over the body.

Tests to Diagnose Granuloma Annulare

There is no really effective treatment. At times the decisions are usually taken based on the subtype of granuloma annulare.

Visible patches or symptomatic may improve using steroid creams or ointments. It may also be helpful to inject steroid injections into the rings; this is not always the case. Another option of treating granuloma annulare is by taking a risk of thinning the skin. Cryotherapy, which is also known as lesions by freezing them is also an excellent alternative in the treatment of very small patches. Granuloma annulare can, however, leave a permanent scar.

There are limited signs for treatments which are able to work in generalized granuloma annulare with no ideal treatment available. Powerful drugs such as antibiotics, steroid tablets, isotretinoin, antimalarial drugs and ultraviolet light treatment and, ciclosporin and dapsone have been reported to help in individual cases. However, in a large number of cases, the symptoms of granuloma annulare do not justify the use of these drugs which all have significant side effects.

Treatment for Granuloma Annulare

There are many instances in which no treatment is necessary for granuloma annulare. Most of the lesions disappear in some time. If you are worried about the appearance of your skin, your doctor can recommend a treatment plan.

Corticosteroid Creams. You will be prescribed corticosteroid topical creams by your doctor for granuloma annulare so as to help improve the image of the lesions.

Depending on the thickness of the lesions and the strength of the cream, you may be directed by your doctor to cover the cream with an adhesive patch or bandages. Covering the steroid cream makes it more effective.

Corticosteroid Injections. If your symptoms of granuloma annulare are greater and the skin lesions are harder, Corticosteroids (triamcinolone, others) may be injected directly by your doctor into the affected skin to help the lesions depart faster.

Cryotherapy. In cryotherapy for granuloma annulare, your doctor applies liquid nitrogen to the 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 may also be recommended by your physician for granuloma annulare

Recovery Period/Healing Time for Granuloma Annulare

The recovery period for patients with granuloma annulare as well as in the other possibilities in the overall prognosis of Granuloma annulare the forecast issues are as per their by nature unpredictable.

Prevention of Granuloma Annulare

Since granuloma annulare at times develops on those areas which exposed to the sun like the hands and forearms, protecting these areas from the sun by covering it with appropriate clothing or by limiting exposure, or applying a high-quality sunscreen may be of some help.

Prognosis/Outlook for Granuloma Annulare

There are certain cases in which the localized granuloma annulare are self-limiting. The other half of the cases will settle within two years. As many as forty percent of the children have recurrent lesions. For the generalised disease the prognosis is worse as someone will be having a chronic course which continue up to ten years, high risk of recurrence and poor response to treatment.

Lifestyle Changes for Granuloma Annulare

There are times when genetics and other factors come into play, if you are overweight as well as inactive, it can have an effect on diabetes.

  • Look after your blood sugar
  • You should follow a healthy diet by eating lots of fruits, vegetables, and whole grains
  • You should stick to an exercise schedule of 30 minutes of cardio, 5 days a week.

Other lifestyle changes include:

  • You should prevent dry skin
  • You should not take hot baths or showers, as they can dry skin out
  • You should also not scratch on the dry skin as it can create lesions thereby allowing the infections to set in
  • During dry months keep your home humid during
  • Treat cuts immediately.

Each patient of granuloma annulare is different, this is why it becomes necessary for you to ensure that you consult your doctor before you change your diet or exercise program.

Risk Factors for Granuloma Annulare

Granuloma annulare is associated with thyroid or diabetes disease. At times it is also associated when the lesions are widespread or numerous.

Granuloma annulare can affect people in any age group and of any sex, certain specializations are these:

You are at greater risk of having the disease if you:

  • You have diabetes mellitus or thyroid disease, although experts don’t know the reason for this association
  • You are over the age of 40.
  • Being women.

Complications of Granuloma Annulare

Some of the possible complications of granuloma annulare are:


  1. American Osteopathic College of Dermatology: Granuloma Annulare
  2. DermNet NZ: Granuloma Annulare
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 5, 2023

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