Granuloma annulare

Typically asymptomatic, and presents as small grouped papules in an annular configuration.

Localised disease is the most common subtype; patients are often women in their 30s.

Most cases are self-limiting, with at least 50% resolving within 2 years. However, recurrences are common.

A possible association with underlying malignancy has been postulated, particularly in older patients with atypical or generalised clinical presentation such as palmar plaques or erythroderma. However, this association has been challenged in a recent cohort study.

Although evidence is limited, may be associated with thyroid disease, hyperlipidaemia, and diabetes.

Granuloma annulare (GA) is an uncommon benign condition of unknown aetiology.[1]Muhlbauer JE. Granuloma annulare. J Am Acad Dermatol. 1980 Sep;3(3):217-30. http://www.ncbi.nlm.nih.gov/pubmed/7005273?tool=bestpractice.com Lesions are typically described as dermal papules, which coalesce to form rings, and may be skin-coloured, pink, or violaceous; commonly found on the back of hands, ankles, knees, and elbows.[Figure caption and citation for the preceding image starts]: Classic localised granuloma annulareFrom the collection of Susmita Mukherjee, BSc, MBBS, MRCP; used with permission [Citation ends]. A number of clinical variants exist.[2]Piette EW, Rosenbach M. Granuloma annulare: clinical and histologic variants, epidemiology, and genetics. J Am Acad Dermatol. 2016 Sep;75(3):457-65. http://www.ncbi.nlm.nih.gov/pubmed/27543209?tool=bestpractice.com Histology is characteristic. Most cases are self-limiting.[3]Cyr PR. Diagnosis and management of granuloma annulare. Am Fam Physician. 2006 Nov 15;74(10):1729-34. http://www.aafp.org/afp/20061115/1729.html http://www.ncbi.nlm.nih.gov/pubmed/17137003?tool=bestpractice.com