What are the types of granuloma annulare?

Answer

The following clinical variants are recognized:

Localized granuloma annulare: This is the most common form. Localized granuloma annulare is characterized by skin-colored to violaceous lesions up to 5 cm in diameter. Usually, the epidermis has attenuated surface markings. Annular rings with solitary firm papules or nodules may be present. Localized granuloma annulare has a predilection for the feet, ankles, lower limbs, and wrists.
Generalized granuloma annulare: This form occurs predominantly in adults. The trunk is usually involved, as well as the neck, extremities, face, scalp, palms, and soles. Lesions range from widespread papules to annular plaques to large, discolored patches with a variety of coloration from yellow to violaceous.
Subcutaneous granuloma annulare^[3]: This form occurs predominantly in children. Subcutaneous granuloma annulare is characterized by firm or hard asymptomatic nodules in the deep dermis or subcutaneous tissues, with individual lesions measuring from 5 mm to 4 cm in diameter. They are prevalent on the anterotibial plateau, ankles, dorsal feet, buttocks, hands, scalp, and eyelids.
Perforating granuloma annulare^[4]: This form is very rare. Perforating granuloma annulare is usually localized to the dorsal hands and fingers or may be generalized on the trunk and extremities. A variety of superficial umbilicated papules develop, with or without a discharge, that heal with scarring.
Arcuate dermal erythema: This is an uncommon form of granuloma annulare that manifests as infiltrated erythematous patches that may form large, hyperpigmented rings with central clearing.

Some authorities consider actinic granuloma (AG) to be a subset of granuloma annulare, but others view actinic annulare as a separate, but related, entity.^[5]

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

Piette EW, Rosenbach M. Granuloma annulare: Pathogenesis, disease associations and triggers, and therapeutic options. J Am Acad Dermatol. 2016 Sep. 75 (3):467-479. [Medline].
Piette EW, Rosenbach M. Granuloma annulare: Clinical and histologic variants, epidemiology, and genetics. J Am Acad Dermatol. 2016 Sep. 75 (3):457-465. [Medline].
Felner EI, Steinberg JB, Weinberg AG. Subcutaneous granuloma annulare: a review of 47 cases. Pediatrics. 1997 Dec. 100(6):965-7. [Medline].
Penas PF, Jones-Caballero M, Fraga J, Sanchez-Perez J, Garcia-Diez A. Perforating granuloma annulare. Int J Dermatol. 1997 May. 36(5):340-8. [Medline].
Ghadially R. Granuloma annulare, actinic granuloma. Arndt K, et al, eds. Cutaneous Medicine and Surgery. WB Saunders Co; 1996. 438-443.
Mehta LR, Rose JW. Recurrent granuloma annulare during treatment with daclizumab. Mult Scler. 2009 Apr. 15(4):527-8. [Medline].
Cornejo CM, Haun P, English J 3rd, Rosenbach M. Immune checkpoint inhibitors and the development of granulomatous reactions. J Am Acad Dermatol. 2019 Nov. 81 (5):1165-1175. [Medline].
Fontecilla NM, Kittler NW, Lopez A, Yang C, Geskin L. Programmed cell death protein-1 inhibitor-induced granuloma annulare and hypertrophic lichen planus masquerading as squamous cell carcinoma. JAAD Case Rep. 2018 Aug. 4 (7):636-639. [Medline].
Wu J, Kwong BY, Martires KJ, Rieger KE, Chung WH, Iyer GV, et al. Granuloma annulare associated with immune checkpoint inhibitors. J Eur Acad Dermatol Venereol. 2018 Apr. 32 (4):e124-e126. [Medline].
Kakourou T, Psychou F, Voutetakis A, Xaidara A, Stefanaki K, Dacou-Voutetakis C. Low serum insulin values in children with multiple lesions of granuloma annulare: a prospective study. J Eur Acad Dermatol Venereol. 2005 Jan. 19(1):30-4. [Medline].
Li A, Hogan DJ, Sanusi ID, Smoller BR. Granuloma annulare and malignant neoplasms. Am J Dermatopathol. 2003 Apr. 25(2):113-6. [Medline].
O'Brien JP, Regan W. Actinically degenerate elastic tissue is the likely antigenic basis of actinic granuloma of the skin and of temporal arteritis. J Am Acad Dermatol. 1999 Feb. 40(2 Pt 1):214-22. [Medline].
De Maeseneer M, Vande Walle H, Lenchik L, Machiels F, Desprechins B. Subcutaneous granuloma annulare: MR imaging findings. Skeletal Radiol. 1998 Apr. 27(4):215-7. [Medline].
Shehan JM, El-Azhary RA. Magnetic resonance imaging features of subcutaneous granuloma annulare. Pediatr Dermatol. 2005 Jul-Aug. 22(4):377-8. [Medline].
Blume-Peytavi U, Zouboulis CC, Jacobi H, Scholz A, Bisson S, Orfanos CE. Successful outcome of cryosurgery in patients with granuloma annulare. Br J Dermatol. 1994 Apr. 130(4):494-7. [Medline].
Sniezek PJ, DeBloom JR 2nd, Arpey CJ. Treatment of granuloma annulare with the 585 nm pulsed dye laser. Dermatol Surg. 2005 Oct. 31 (10):1370-3. [Medline].
Sliger BN, Burk CJ, Alvarez-Connelly E. Treatment of granuloma annulare with the 595 nm pulsed dye laser in a pediatric patient. Pediatr Dermatol. 2008 Mar-Apr. 25 (2):196-7. [Medline].
Liu A, Hexsel CL, Moy RL, Ozog DM. Granuloma annulare successfully treated using fractional photothermolysis with a 1,550-nm erbium-doped yttrium aluminum garnet fractionated laser. Dermatol Surg. 2011 May. 37 (5):712-5. [Medline].
Bronfenbrener R, Ragi J, Milgraum S. Granuloma annulare treated with excimer laser. J Clin Aesthet Dermatol. 2012 Nov. 5 (11):43-5. [Medline].
Passeron T, Fusade T, Vabres P, Bousquet-Rouaud R, Collet-Vilette AM, Dahan S, et al. Treatment of granuloma annulare with the 595-nm pulsed dye laser, a multicentre retrospective study with long-term follow-up. J Eur Acad Dermatol Venereol. 2011 Dec 21. [Medline].
Harth W, Linse R. Topical tacrolimus in granuloma annulare and necrobiosis lipoidica. Br J Dermatol. 2004 Apr. 150(4):792-4. [Medline].
Jain S, Stephens CJ. Successful treatment of disseminated granuloma annulare with topical tacrolimus. Br J Dermatol. 2004 May. 150(5):1042-3. [Medline].
Rigopoulos D, Prantsidis A, Christofidou E, Ioannides D, Gregoriou S, Katsambas A. Pimecrolimus 1% cream in the treatment of disseminated granuloma annulare. Br J Dermatol. 2005 Jun. 152(6):1364-5. [Medline].
Lopez-Navarro N, Castillo R, Gallardo MA, Alcaide A, Matilla A, Herrera E. Successful treatment of perforating granuloma annulare with 0.1% tacrolimus ointment. J Dermatolog Treat. 2008. 19 (6):376-7. [Medline].
Grieco T, Cantisani C, Faina P, Cantoresi F, Lacobellis F, Silvestri E, et al. Tacrolimus 0.1% and granuloma annulare: description of three cases. J Eur Acad Dermatol Venereol. 2009 Dec. 23 (12):1445-6. [Medline].
Gomez-Moyano E, Vera-Casaño A, Martinez S, Sanz A. Periorbital granuloma annulare successfully treated with tacrolimus 0.1% ointment. Int J Dermatol. 2014 Feb. 53 (2):e156-7. [Medline].
Kuwahara RT, Naylor MF, Skinner RB. Treatment of granuloma annulare with topical 5% imiquimod cream. Pediatr Dermatol. 2003 Jan-Feb. 20(1):90. [Medline].
Badavanis G, Monastirli A, Pasmatzi E, Tsambaos D. Successful treatment of granuloma annulare with imiquimod cream 5%: a report of four cases. Acta Derm Venereol. 2005. 85(6):547-8. [Medline].
Errichetti E, Stinco G, Pegolo E, Patrone P. Generalized Granuloma Annulare in a Cirrhotic Patient Treated with Narrowband Ultraviolet B Therapy. Indian J Dermatol. 2016 Jan-Feb. 61 (1):127. [Medline].
Ine K, Kabashima K, Koga C, Kobayashi M, Tokura Y, Kabashima K. Eruptive generalized granuloma annulare presenting with numerous micropapules. Int J Dermatol. 2010 Jan. 49 (1):104-5. [Medline].
Inui S, Nishida Y, Itami S, Katayama I. Disseminated granuloma annulare responsive to narrowband ultraviolet B therapy. J Am Acad Dermatol. 2005 Sep. 53 (3):533-4. [Medline].
Samson Yashar S, Gielczyk R, Scherschun L, Lim HW. Narrow-band ultraviolet B treatment for vitiligo, pruritus, and inflammatory dermatoses. Photodermatol Photoimmunol Photomed. 2003 Aug. 19 (4):164-8. [Medline].
Yong A, Chong WS, Pan JY. Disseminated granuloma annulare responding to narrowband UVB phototherapy. Photodermatol Photoimmunol Photomed. 2016 Mar. 32 (2):107-9. [Medline].
Mikami E, Yanase M, Ito M, Kanzaki A, Saeki H. Generalized granuloma annulare successfully treated with narrowband ultraviolet B and anti-hepatitis C virus therapy. J Dermatol. 2016 Feb 19. [Medline].
Pavlovsky M, Samuelov L, Sprecher E, Matz H. NB-UVB phototherapy for generalized granuloma annulare. Dermatol Ther. 2015 Dec 2. [Medline].
Kerker BJ, Huang CP, Morison WL. Photochemotherapy of generalized granuloma annulare. Arch Dermatol. 1990 Mar. 126(3):359-61. [Medline].
Batchelor R, Clark S. Clearance of generalized papular umbilicated granuloma annulare in a child with bath PUVA therapy. Pediatr Dermatol. 2006 Jan-Feb. 23 (1):72-4. [Medline].
Grundmann-Kollmann M, Ochsendorf FR, Zollner TM, Tegeder I, Kaufmann R, Podda M. Cream psoralen plus ultraviolet A therapy for granuloma annulare. Br J Dermatol. 2001 May. 144 (5):996-9. [Medline].
Browne F, Turner D, Goulden V. Psoralen and ultraviolet A in the treatment of granuloma annulare. Photodermatol Photoimmunol Photomed. 2011 Apr. 27 (2):81-4. [Medline].
Looney M, Smith KM. Isotretinoin in the treatment of granuloma annulare. Ann Pharmacother. 2004 Mar. 38(3):494-7. [Medline].
Schleicher SM, Milstein HJ. Resolution of disseminated granuloma annulare following isotretinoin therapy. Cutis. 1985 Aug. 36 (2):147-8. [Medline].
Schleicher SM, Milstein HJ, Lim SJ, Stanton CD. Resolution of disseminated granuloma annulare with isotretinoin. Int J Dermatol. 1992 May. 31 (5):371-2. [Medline].
Tang WY, Chong LY, Lo KK. Resolution of generalized granuloma annulare with isotretinoin therapy. Int J Dermatol. 1996 Jun. 35 (6):455-6. [Medline].
Sahin MT, Türel-Ermertcan A, Oztürkcan S, Türkdogan P. Generalized granuloma annulare in a patient with type II diabetes mellitus: successful treatment with isotretinoin. J Eur Acad Dermatol Venereol. 2006 Jan. 20 (1):111-4. [Medline].
Pasmatzi E, Georgiou S, Monastirli A, Tsambaos D. Temporary remission of disseminated granuloma annulare under oral isotretinoin therapy. Int J Dermatol. 2005 Feb. 44 (2):169-71. [Medline].
Adams DC, Hogan DJ. Improvement of chronic generalized granuloma annulare with isotretinoin. Arch Dermatol. 2002 Nov. 138 (11):1518-9. [Medline].
Grewal SK, Rubin C, Rosenbach M. Antimalarial therapy for granuloma annulare: Results of a retrospective analysis. J Am Acad Dermatol. 2017 Apr. 76 (4):765-767. [Medline].
Cannistraci C, Lesnoni La Parola I, Falchi M, Picardo M. Treatment of generalized granuloma annulare with hydroxychloroquine. Dermatology. 2005. 211 (2):167-8. [Medline].
Simon M Jr, von den Driesch P. Antimalarials for control of disseminated granuloma annulare in children. J Am Acad Dermatol. 1994 Dec. 31 (6):1064-5. [Medline].
Piaserico S, Zattra E, Linder D, Peserico A. Generalized granuloma annulare treated with methylaminolevulinate photodynamic therapy. Dermatology. 2009. 218(3):282-4. [Medline].
Weisenseel P, Kuznetsov AV, Molin S, Ruzicka T, Berking C, Prinz JC. Photodynamic therapy for granuloma annulare: more than a shot in the dark. Dermatology. 2008. 217(4):329-32. [Medline].
Calzavara-Pinton PG, Rossi MT, Sala R, Italian Group For Photodynamic Therapy. A retrospective analysis of real-life practice of off-label photodynamic therapy using methyl aminolevulinate (MAL-PDT) in 20 Italian dermatology departments. Part 2: oncologic and infectious indications. Photochem Photobiol Sci. 2013 Jan. 12 (1):158-65. [Medline].
Marcus DV, Mahmoud BH, Hamzavi IH. Granuloma annulare treated with rifampin, ofloxacin, and minocycline combination therapy. Arch Dermatol. 2009 Jul. 145(7):787-9. [Medline].
Garg S, Baveja S. Monthly rifampicin, ofloxacin, and minocycline therapy for generalized and localized granuloma annulare. Indian J Dermatol Venereol Leprol. 2015 Jan-Feb. 81 (1):35-9. [Medline].
Steiner A, Pehamberger H, Wolff K. Sulfone treatment of granuloma annulare. J Am Acad Dermatol. 1985 Dec. 13 (6):1004-8. [Medline].
Czarnecki DB, Gin D. The response of generalized granuloma annulare to dapsone. Acta Derm Venereol. 1986. 66 (1):82-4. [Medline].
Wolf F, Grezard P, Berard F, Clavel G, Perrot H. Generalized granuloma annulare and hepatitis B vaccination. Eur J Dermatol. 1998 Sep. 8 (6):435-6. [Medline].
Saied N, Schwartz RA, Estes SA. Treatment of generalized granuloma annulare with dapsone. Arch Dermatol. 1980 Dec. 116 (12):1345-6. [Medline].
Visconti MJ, Ashack KA, Ashack RJ. Granuloma annulare: strengthening potential associations and pentoxifylline as a therapeutic option. J Dermatolog Treat. 2019 Sep 10. 1-2. [Medline].
Wong GN, Wee E, Tam M, Kelly R. Pentoxifylline as a treatment for granuloma annulare. Australas J Dermatol. 2019 Nov. 60 (4):328-331. [Medline].
Weber HO, Borelli C, Rocken M, Schaller M. Treatment of disseminated granuloma annulare with low-dose fumaric acid. Acta Derm Venereol. 2009. 89(3):295-8. [Medline].
Shupack J, Siu K. Resolving granuloma annulare with etanercept. Arch Dermatol. 2006 Mar. 142 (3):394-5. [Medline].
Kreuter A, Altmeyer P, Gambichler T. Failure of etanercept therapy in disseminated granuloma annulare. Arch Dermatol. 2006 Sep. 142 (9):1236-7; author reply 1237. [Medline].
Antoñanzas J, Rodríguez-Garijo N, Tomás-Velázquez A, Estenaga A, Andrés-Ramos I, España Alonso A. Treatment of recalcitrant reactive granulomatous dermatitis: Granuloma annulare subtype with etanercept. Dermatol Ther. 2020 Jul 26. e14081. [Medline].
Murdaca G, Negrini S, Magnani O, Penza E, Pellecchio M, Gulli R, et al. Update upon efficacy and safety of etanercept for the treatment of spondyloarthritis and juvenile idiopathic arthritis. Mod Rheumatol. 2018 May. 28 (3):417-431. [Medline].
Hertl MS, Haendle I, Schuler G, Hertl M. Rapid improvement of recalcitrant disseminated granuloma annulare upon treatment with the tumour necrosis factor-alpha inhibitor, infliximab. Br J Dermatol. 2005 Mar. 152 (3):552-5. [Medline].
Murdaca G, Colombo BM, Barabino G, Caiti M, Cagnati P, Puppo F. Anti-tumor necrosis factor-α treatment with infliximab for disseminated granuloma annulare. Am J Clin Dermatol. 2010 Dec 1. 11 (6):437-9. [Medline].
Amy de la Breteque M, Saussine A, Rybojad M, Kramkimel N, Vignon Pennamen MD, Bagot M, et al. Infliximab in recalcitrant granuloma annulare. Int J Dermatol. 2016 Feb. 55 (2):220-2. [Medline].
Rosmarin D, LaRaia A, Schlauder S, Gottlieb AB. Successful treatment of disseminated granuloma annulare with adalimumab. J Drugs Dermatol. 2009 Feb. 8(2):169-71. [Medline].
Torres T, Pinto Almeida T, Alves R, Sanches M, Selores M. Treatment of recalcitrant generalized granuloma annulare with adalimumab. J Drugs Dermatol. 2011 Dec. 10(12):1466-8. [Medline].
Min MS, Lebwohl M. Treatment of recalcitrant granuloma annulare (GA) with adalimumab: A single-center, observational study. J Am Acad Dermatol. 2016 Jan. 74 (1):127-33. [Medline].
Mahmood T, Mansouri B, Menter A. Successful treatment of generalized granuloma annulare with adalimumab. Clin Exp Dermatol. 2015 Jul. 40 (5):537-9. [Medline].
Werchau S, Enk A, Hartmann M. Generalized interstitial granuloma annulare--response to adalimumab. Int J Dermatol. 2010 Apr. 49 (4):457-60. [Medline].
Fässler M, Schlapbach C. Granuloma annulare arising under systemic psoriasis therapy successfully treated with adalimumab. JAAD Case Rep. 2020 Sep. 6 (9):832-834. [Medline].
Wang A, Singh K, Ibrahim W, King B, Damsky W. The Promise of JAK Inhibitors for Treatment of Sarcoidosis and Other Inflammatory Disorders with Macrophage Activation: A Review of the Literature. Yale J Biol Med. 2020 Mar. 93 (1):187-195. [Medline].
Damsky W, Singh K, Galan A, King B. Treatment of necrobiosis lipoidica with combination Janus kinase inhibition and intralesional corticosteroid. JAAD Case Rep. 2020 Feb. 6 (2):133-135. [Medline].
Damsky W, Thakral D, McGeary MK, Leventhal J, Galan A, King B. Janus kinase inhibition induces disease remission in cutaneous sarcoidosis and granuloma annulare. J Am Acad Dermatol. 2020 Mar. 82 (3):612-621. [Medline].
Blum S, Altman D. Treatment of generalized granuloma annulare with apremilast: A report of 2 cases. JAAD Case Rep. 2019 Nov. 5 (11):976-978. [Medline].
Bishnoi A, Raj D, Vinay K, Dogra S. Refractory Generalized Granuloma Annulare Treated With Oral Apremilast. JAMA Dermatol. 2019 Aug 21. [Medline].
Gass JK, Todd PM, Rytina E. Generalized granuloma annulare in a photosensitive distribution resolving with scarring and milia formation. Clin Exp Dermatol. 2009 Jul. 34(5):e53-5. [Medline].

Media Gallery

Granuloma annulare. By Mierlo at English Wikipedia - Transferred from en.wikipedia to Commons by Stevenfruitsmaak using CommonsHelper., Public Domain, https://commons.wikimedia.org/w/index.php?curid=4560836.

of 1

Author

Ruby Ghadially, MBChB, FRCP(C)Derm Professor, Department of Dermatology, University of California, San Francisco, School of Medicine

Ruby Ghadially, MBChB, FRCP(C)Derm is a member of the following medical societies: American Academy of Dermatology, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Akos Z Szabo, MD Resident Physician, Department of Obstetrics and Gynecology, University of Heidelberg Medical Center, Germany

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD.

Additional Contributors

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Amit Garg, MD Director of Clinical Elective in Dermatology, Assistant Professor, Department of Internal Medicine, Division of Dermatology, University of Massachusetts Medical School

Amit Garg, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Student Association/Foundation

Disclosure: Abbott Immunology Honoraria Speaking and teaching; Centocor Grant/research funds Other; RegenRx Grant/research funds Other

What are the types of granuloma annulare?

Related Questions:

References

Tables

Contributor Information and Disclosures