Symptoms

Granuloma annulare is generally marked by:

• Raised, reddish or skin-colored bumps (lesions) that can expand or join to form ring patterns, most commonly on your hands and feet. The patterns may resemble ringworm.
• Mild itching in some people, though the lesions usually cause no pain or itching.

Although the lesions may be unsightly, granuloma annulare usually causes no other signs or symptoms. The lesions may disappear and reappear at a later time.

A more severe, widespread form of this condition is called generalized granuloma annulare. In generalized granuloma annulare, rings appear over much of your body, lesions are often smaller, and itching is more common.

When to see a doctor
Call your doctor if your skin develops reddish bumps (lesions) in ring patterns that don't go away within a few weeks.

Causes

The cause of granuloma annulare is unknown.

Granuloma annulare is occasionally associated with diabetes mellitus and other diseases, though most often when lesions are numerous or generalized. Most people with granuloma annulare are otherwise healthy.

Risk factors

Though granuloma annulare can affect people in any age group and of any sex, there are some generalizations. Risk factors include:

• Being a woman — women are twice as likely to have granuloma annulare
• Being a child or young adult

You're at greater risk of generalized, or widespread, granuloma annulare if:

• You're over the age of 40
• You have diabetes mellitus or thyroid disease, although experts don't know the reason for this association

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases you may be referred to a specialist in skin conditions called a dermatologist.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any recent vacations, time spent outdoors or interactions with animals, including your own pets.
• Make a list of your key medical information, including other conditions you're being treated for and the names of all medications that you're taking. Include any vitamins or supplements.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List and ask your questions from most important to least important. For granuloma annulare, some basic questions to ask your doctor include:

• What is likely causing my condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• Does this condition cause any long-term health problems?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Do I need to take prescription medicine? If so, is there a generic alternative?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did your skin condition first appear?
• Does your rash cause any discomfort? Does it itch?
• Have your symptoms become worse or stayed the same over time?
• Have you recently traveled to a new area or spent significant time outdoors?
• Do you have pets, or have you recently had contact with new animals?
• Are any family members or friends having similar symptoms?
• Have you been treating your skin condition with any medications or creams?
• Does anything seem to improve — or worsen — your symptoms?
• Do you have any other health conditions, such as diabetes or thyroid problems?

Tests and diagnosis

In many cases, your doctor can diagnose granuloma annulare by examining the affected skin. To confirm a case of granuloma annulare or rule out other conditions, your doctor may recommend these tests:

• KOH test. In this test, your doctor scrapes your skin with a glass slide to collect dead skin cells. The skin cells are mixed with potassium hydroxide (KOH) and viewed under a microscope to help determine if you have a fungal infection.
• Skin biopsy. In this test, a small sample of the affected skin is removed. The skin sample is examined under a microscope to confirm a diagnosis of granuloma annulare.

Treatment and drugs

In most cases, no treatment is necessary for granuloma annulare. Most lesions disappear within a few months to two years.

If the appearance of the rash bothers you, your doctor can recommend a treatment plan. This may include:

• Corticosteroid creams or ointments. Your doctor may prescribe corticosteroid topical creams to help improve the appearance of the lesions and speed their disappearance. Depending on the thickness of the lesions and the strength of the cream, your doctor may direct you to cover the cream with bandages or an adhesive patch. Covering the steroid cream makes it more effective.
• Corticosteroid injections. If the skin lesions are thicker and your symptoms are greater, your doctor may inject corticosteroids (triamcinolone, others) directly into the affected skin to help the lesions disappear faster.
• Freezing the lesions (cryotherapy). In cryotherapy, your doctor applies liquid nitrogen to the affected 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
In severe cases of generalized granuloma annulare, your doctor may recommend a special kind of ultraviolet light therapy called psoralen plus ultraviolet A (PUVA). This treatment combines exposure to ultraviolet light (phototherapy) with drugs called psoralens, which help make your skin more receptive to the effects of ultraviolet light.

Prevention

Since granuloma annulare often develops on the sun-exposed areas of the hands and forearms, protecting these areas from the sun by limiting exposure, covering with appropriate clothing or applying a high-quality sunscreen (SPF 15 or higher) may be of some help.