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Granuloma annulare in Adult
See also in: External and Internal Eye
Other Resources UpToDate PubMed

Granuloma annulare in Adult

See also in: External and Internal Eye
Contributors: Lauren Strazzula MD, Vivian Wong MD, PhD, Susan Burgin MD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed

Synopsis

Granuloma annulare (GA) is a benign granulomatous inflammatory disorder of the dermis or subcutis. Its cause is unknown. Small dermal papules may present in isolation or coalesce to form smooth annular plaques, often on extremities. Lesions are typically asymptomatic or only mildly pruritic, but the appearance may cause patients distress. The disease is more common in women (female-to-male ratio of 2:1), and two-thirds of patients are aged younger than 30. The disease usually resolves spontaneously with no adverse sequelae, though some cases prove persistent or recurrent.

Some reports in the literature have suggested that GA is associated with certain triggers or systemic diseases, most commonly diabetes mellitus; other diseases that may be associated include thyroid disease, dyslipidemia, malignancy, and infections.

There are 3 principal variants of GA: localized (75% of cases), generalized (or disseminated), and subcutaneous (also known as pseudo-rheumatoid nodules). Patch GA is a variant of localized GA in which the plaques are extremely thin and barely palpable. A fourth type – perforating GA – refers to rare lesions that demonstrate histologic evidence of transepidermal extrusion of degraded collagen. Actinic granuloma presents with similar lesions and is thought by some to represent GA occurring in sun-damaged skin. Palmoplantar GA is a rare variant favoring the palms.

Codes

ICD10CM:
L92.0 – Granuloma annulare

SNOMEDCT:
65508009 – Granuloma annulare

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • GA is often mistaken for dermatophyte infection (Tinea corporis, or "ringworm"). The presence of scale in dermatophyte infection should allow the distinction.
  • Subcutaneous forms of GA may be confused with Rheumatoid nodule.
  • Interstitial granulomatous dermatitis
  • Palisaded neutrophilic granulomatous dermatitis
  • Panniculitis
  • Reactive perforating collagenosis
  • Elastosis perforans serpiginosa
  • Sarcoidosis
  • Erythema annulare centrifugum
  • Lichen planus (especially the annular variant) – Usually pruritic.
  • Leprosy – Anesthetic lesions in endemic countries.
  • Erythema elevatum diutinum – Over extensors, pruritic.
  • Necrobiosis lipoidica – Atrophic plaques.
  • Erythema migrans (Lyme disease) – Slow growing, more erythematous.
  • Erythema gyratum repens
  • Acute febrile neutrophilic dermatosis
  • Subacute cutaneous lupus erythematosus
  • Actinic granuloma
  • Pseudolymphoma
  • Cutaneous T-cell lymphoma

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated:12/11/2023
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Granuloma annulare in Adult
See also in: External and Internal Eye
A medical illustration showing key findings of Granuloma annulare : Ankle, Dorsum of foot, Dorsum of hand, Fingers
Clinical image of Granuloma annulare - imageId=25856. Click to open in gallery.  caption: 'Annular, orange-red, smooth plaque on the dorsal hand.'
Annular, orange-red, smooth plaque on the dorsal hand.
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