Granuloma Annulare

The cause is unknown, but granuloma annulare does not damage the general health, and is not infectious or due to allergies. Some types of granuloma annulare have been linked with diabetes but this is very uncommon in the ordinary type. It usually affects children and young adults.

Granuloma annulare is not hereditary.

In most cases, granuloma annulare causes no symptoms, or a just mild itch at the start of any new area. It can be tender if knocked.

In most patients, patches occur on only one or two sites of the body, often on bony areas such as the backs of the hand, elbows or ankles. Each patch consists of tiny bumps arranged in a ring.

Typically, the rings slowly grow to 1 or 2 inches across but become flatter and rather more purple in colour as they do so, and then gradually fade. Patients can develop a more widespread rash, but this is rare. A deeper form of the condition, called subcutaneous granuloma annulare, may also occur on rare occasions, particularly in children. It manifests as firm lumps under the skin.

The diagnosis of granuloma annulare is usually based on the appearance of the skin lesions. In some instances, especially in the less common types, a skin biopsy helps to prove the clinical diagnosis. A urine test for sugar is often performed too, as there is a slightly increased risk of diabetes for those with the less common, widespread type of granuloma annulare.

Granuloma annulare usually goes away by itself in about 2 years after onset; however, this cannot be predicted accurately on an individual basis.

Unfortunately there is no really effective treatment. Troublesome patches may improve using steroid creams or ointments, or occasionally steroid injections into the rings, but this is not always the case and such treatment is not recommended in every individual, as there is some risk of thinning the skin.

 In general, granuloma annulare does not respond to treatment with tablets, though a number of drugs have been reported to help in individual cases. A special form of ultraviolet light treatment known as narrow-band UVB has also been successful in some people with widespread granuloma annulare. For most patients, no treatment is suggested.

• • There is not a great deal you can do to influence the course of granuloma annulare. Modifying your diet will make no difference. However, cosmetic creams or fake tans may help to conceal the affected patches.