Granuloma Annulare

February 3, 2017

Granuloma annulare is a common skin condition characterized by bumps appearing over the joints and the backs of the hands. Its cause is not known, and most episodes of granuloma annulare clear up after a few years, with or without treatment.

Granuloma annulare (GA) is a relatively common inflammatory skin condition, which can manifest with cutaneous eruptions in a handful of patterns. GA tends to occur in the third to fifth decades of life.

Localized ranuloma annulare most often affects children and young adults. It is slightly more common in girls. The condition is usually seen in otherwise healthy people. Occasionally, it may be associated with diabetes or thyroid disease. Generalized granuloma annulare occurs more commonly in older patients.


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.

There are a number of conditions that are associated with it. The following is a list:

  • Autoimmune disease
  • Cancer
  • Chemotherapy drugs that interfere with the immune system
  • Diabetes
  • Drug reaction – Studies indicates amlodipine as a cause. Amlodipine is used alone or in combination with other medications to treat high blood pressure and chest pain (angina). It is in a class of medications called calcium channel blockers. Allopurinol is another medicine that can rarely cause granuloma annulare. There may be other drugs that induce this skin condition that we may not be aware of yet and possible ones to look into in the future include Zocor, Fosamax, levoxyl and topiramate.
  • Giardia infection
  • Hepatitis B and C infection
  • Herpes Zoster
  • Immunosuppression
  • Leukemia and Lymphoma
  • Thyroid disease including autoimmune thyroiditis
  • Vaccination with tetanus, BCG,
  • Granuloma annulare skin lesions have developed in patients during anti-tumor necrosis factor (TNF) therapy.
  • SSRI antidepressants may be a rare cause


Granuloma annulare usually causes no other symptoms, but the rash may be slightly itchy.

Patients usually notice a ring of small, firm bumps (papules) over the backs of the forearms, hands, or feet. Occasionally, they may find a number of rings. Granuloma annulare occurs most frequently over the joints or in areas that experience mild injury. The most common locations for granuloma annulare include –

  • Backs of the hands and tops of the fingers
  • Tops of the feet
  • Around the elbows
  • Around the knees

The lesions of granuloma annulare are usually found in the same areas on both sides of the body (symmetrically).

Rarely, granuloma annulare may appear as a firm nodule under the skin of the arms or legs. In some cases, the rash may spread all over the body. Patients over the age of 40 may often experience more intense itching with widespread granuloma annulare.

The signs and symptoms of granuloma annulare can vary, depending on the variety –

  • Localized – This is the most common type of granuloma annulare. The lesion borders have a circular or semicircular shape, with a diameter up to 2 inches (5 centimeters). It occurs most commonly on the hands, feet, wrists and ankles of young adults, particularly women.
  • Generalized – Up to 15 percent of the people who have granuloma annulare have lesions over a large portion of their bodies — including the trunk, arms and legs. This variety is more likely to be itchy and most often affects adults.
  • Subcutaneous – Occurring predominantly in young children, this type of granuloma annulare produces a firm lump under the skin instead of a rash. The lump is usually less than 1.5 inches (3.8 centimeters) in diameter.


  • Corticosteroid creams or ointments – Prescription-strength products may help improve the appearance of the lesions and speed their disappearance.
  • Corticosteroid injections – If the skin lesions are thicker and the symptoms are greater, the doctor may inject corticosteroids directly into the lesions to help them disappear faster.
  • Freezing the lesions – Applying liquid nitrogen to the affected area can help remove the lesions and stimulate the growth of new skin.
  • Light therapy – Exposing the lesions to particular types of light is sometimes helpful. Certain types of laser treatments also work for some people.
  • Oral medications – In severe cases, especially when the lesions are widespread, your doctor might prescribe drugs used to prevent immune system reactions in people who have rheumatoid arthritis or who have received an organ transplant.

Alternative Treatment

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