Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options

Tejas P. Joshi; Madeleine Duvic


Am J Clin Dermatol. 2022;23(1):37-50. 

In This Article


A 2021 study by Barbieri et al. of 11,608 patients with incident GA and 17,862 patients with prevalent GA helps to establish the epidemiology of GA in the US. The study investigators report the incidence of GA to be 0.04% and note both the incidence and prevalence of disease to be most frequent during the fifth decade of life. Moreover, GA has a predilection for women, with a female-to-male ratio of 3:1. Incidence and prevalence also appears to be more common among Caucasians and individuals with a higher household income and educational attainment. Nevertheless, it is unclear whether this difference is due to genetic and environmental factors or merely due to a lower likelihood of racial minorities and individuals with lower educational attainment seeking medical attention.[10] A recent study of 180 GA patients in the All of Us Research Program, a National Institutes of Health database that includes groups that have been historically underrepresented in research, also reports GA to be more prevalent among White patients compared with non-White patients, suggesting that a genetic predisposition may indeed be likely, although further studies are still needed to establish such an association.[11]

The study by Barbieri et al. also provides data on commonly prescribed treatments. Topical and intralesional corticosteroids appear to be the de facto first-line treatments for GA, with 41.5% of GA patients filling a prescription for topical corticosteroids and 9.4% of GA patients receiving injections for intralesional corticosteroids within 6 months of being diagnosed. Tetracycline and hydroxychloroquine (HCQ) were also prescribed as first-line treatments at a frequency of 7.1% and 2.3%, respectively. Interestingly, phototherapy, despite being the most efficacious and evidence-based treatment currently available, was utilized by only 0.5% of patients, suggesting that perhaps logistical and financial constraints may preclude phototherapy from being a viable treatment option.[10]