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Granuloma annulare: Diagnosis and treatment


How do dermatologists diagnose granuloma annulare?

If you may have granuloma annulare annulare, your dermatologist will exam your skin and ask some questions.

Be sure to tell your dermatologist if you:

  • Have injured your skin recently

  • Feel any pain or itch

  • Take any medications

  • Have been diagnosed with a disease

The skin exam and information you provide are often enough to diagnose granuloma annulare.

If it looks like you may have another condition, you may need medical testing. To test for another condition, your dermatologist may remove a bit of skin, so that it can be examined under a microscope. This is called a skin biopsy.

Your dermatologist can quickly remove the skin needed for a skin biopsy during your exam. A skin biopsy helps rule out a condition, such as a skin infection.

Medical tests, such as a blood test or CT scan, can also help rule out other diseases.

Testing is important because some research studies show that people with granuloma annulare have a higher risk of developing a few other diseases, such as diabetes, thyroid disease, or HIV (human immunodeficiency virus). Not all research studies have found this to be true. Until we know for sure, it can be helpful for some people to get tested for these diseases.

How do dermatologists treat granuloma annulare?

Most people don’t need treatment. This skin condition tends to clear on its own. Since it’s not contagious, you can leave it alone until it clears. Clearing may take a few months or a few years. Most people see their skin clear within two years.

Many people who have granuloma annulare don’t need treatment.

If you have a type of granuloma annulare that covers a large area of your body or causes a deep growth in your skin, your dermatologist may recommend treatment. Treatment may also be an option if you have noticeable patches and dislike how your skin looks.

If you have a few noticeable patches, these are often treated with:

  • Corticosteroids you apply to your skin: This medication reduces inflammation, which can help your skin clear more quickly.

  • Injections of a corticosteroid: Your dermatologist may inject the patches to reduce the inflammation, which can help your skin clear more quickly.

  • Cryotherapy: This freezes your skin, which can destroy the raised patches.

If the granuloma annulare covers much of your skin or you have a deep lump in your skin, you’ll have different treatment options. For these types of granuloma annulare, you may need:

  • Medication used to treat malaria: Studies have shown that this can be quite effective. It can take time to see the results. In one study, patients started to see results after taking the medication for about 3 months.

  • Light therapy: Exposing the skin with granuloma annulare to ultraviolet (UV) light in a controlled way can be helpful. Some people receive a type of light therapy called PUVA. This involves taking a medication called psoralen and then treating the skin with UVA light. The medication makes your skin more sensitive to light, so light therapy can be more effective. Another type of light therapy, laser treatments, can also be helpful.

Some cases of granuloma annulare can be stubborn. The first treatment you try may not work. For this reason, dermatologists use different treatments that can help clear the skin.

While granuloma annulare is not an infection, an antibiotic may help be helpful for some people.

Before using a treatment, your dermatologist will weigh the risk of possible side effects against the effects that granuloma annulare has on your quality of life.

No one treatment has proven effective for everyone. Some people need to try different options before finding treatment that works.

What is the outcome for someone who has granuloma annulare?

The skin usually clears on its own without treatment.

How long it takes the skin to clear varies. Some people clear in a few months. Most people see the signs go away within two years. Clearing can also take longer.

When granuloma annulare clears, it tends to clear without leaving a trace. If you develop a rare type called perforating granuloma annulare, you may see scarring when the granuloma annulare clears.

While granuloma annulare usually clears on its own, it also tends to return. It may return months or years after it clears. This happens whether or not you treat it. When it returns, it tends to appear in the same place and clear more quickly.


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References
Ghadially R. “Granuloma annulare.” Medscape. Updated Sep 7, 2017. Last accessed Feb 28, 2018.

Grewal SK, Rubin C, et al. “Antimalarial therapy for granuloma annulare: Results of a retrospective analysis.” J Am Acad Dermatol 2017; 76:765-67.

Howard A and White, Jr., CR. “Non-infectious granulomas.” In: Wolff K, et al. Fitzpatrick’s dermatology in general medicine (7th edition). McGraw Hill Medical, USA, 2008:1426-9.

Piette EW and Rosenbach M. “Granuloma annulare: Clinical and histologic variants, epidemiology, and genetics.” J Am Acad Dermatol 2016; 75:457-65.

Piette EW and Rosenbach M. “Granuloma annulare: Pathogenesis, disease associations and triggers, and therapeutic options.” J Am Acad Dermatol 2016; 75:467-9.

Prendiville JS. “Granuloma annulare.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:369-73.

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