Granuloma annulare (GA) is a common inflammatory skin disorder of unknown etiology involving the dermis or subcutaneous tissues. The disease is seen in children and adults, and incidence peaks in the third or fourth decade of life. The condition is more common in girls than boys.
Several variants of GA exist, including localized (the most common), generalized, subcutaneous, perforating, macular, vesicular, palmoplantar, and blaschkolinear variants. Generalized forms of GA are more chronic or persistent than localized forms. Palmoplantar GA can be painful. The subcutaneous variant occurs almost exclusively in children and favors the lower extremities.
Human leukocyte antigen (HLA)-Bw35 has been associated with generalized GA and thyroid disease.
GA may have a prolonged course, but lesions tend to spontaneously resolve without scarring.
Granuloma annulare in Child
See also in: External and Internal EyeAlerts and Notices
Synopsis
Codes
ICD10CM:
L92.0 – Granuloma annulare
SNOMEDCT:
65508009 – Granuloma annulare
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 most often mistaken for dermatophyte infection (tinea corporis, or "ringworm"). The presence of scaling in the annular plaques of a dermatophyte infection should allow the distinction. However, tinea incognito similarly lacks scale and should be considered in the appropriate context. Additionally, dermatophyte infection can be diagnosed by potassium hydroxide (KOH) examination of associated scale.
- Sarcoidosis can be annular and similar in appearance.
- Subcutaneous GA is often mistaken for rheumatoid nodules or malignancy. Coexisting papular or annular lesions are frequently seen in patients with this form of GA.
- Erythema annulare centrifugum may be distinguished from GA by characteristic trailing scale at the inner border of the annular erythema.
- Lichen planus may occasionally present with annular lesions; however, these lesions tend to be flat-topped and violaceous with an overlying network of fine white lines (Wickham striae).
- Necrobiosis lipoidica presents as violaceous to red-brown plaques with atrophic yellow-brown centers on the shins.
- Perforating GA or a papular form of GA can be mistaken for molluscum contagiosum.
- Interstitial granulomatous dermatitis
- Palisaded neutrophilic granulomatous dermatitis
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 Reviewed:10/12/2020
Last Updated:07/09/2023
Last Updated:07/09/2023
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Granuloma annulare in Child
See also in: External and Internal Eye