Granuloma Annulare

Not All Rings Are Ringworm

What is granuloma annulare?  Granuloma annulare is a common disorder of the skin.  The name granuloma implies that there is inflammation in the dermis or deeper layer of the skin.  Annulare describes that it often forms rings or annular patterns of rash. The annular lesions often start as a bump about the size of a pencil eraser.  Then the lesions enlarge and the center clears as in the photo.  The active area is the red area at the edge only.

Who has granuloma annulare?  It is seen at all ages and can have an onset early or late in life.  It is not contagious.  Some people are prone to having this disorder.  Those who have the disorder often experience flares and remission throughout their life in a seemingly random fashion.

What other disorders look like granuloma annulare? In its classic annular form, it is often confused with tinea corporis or “ringworm”. 

Is it always in rings?  No, there are other forms that occur most often on the abdomen or inner thighs that look like flat mauve color skin that seems to persist.

Can it spread to the whole body?  Most commonly granuloma annulare occurs on the arms and legs, wrists, ankles, elbows in small areas.  However, rarely patients can have hundreds of lesions covering the arms, legs, trunk, neck, but almost never on the face. We have a few patients who have the disseminated form.  This is more difficult to treat, but it can respond to medical UV light treatment.

How is it treated? Most commonly it responds well to strong topical steroids.  However, we cannot use these strong steroids on tender skin like the inner thighs, so often we use Elidel or Protopic, non-steroid topicals in areas.  The disseminated form is more difficult to treat.  A number of oral immunosuppressants can be tried, but all have pretty severe side effects.  Some of our patients with the disseminated form have responded well to NBUVB treatments in the office.

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