Granuloma annulare (GA) is a skin disease commonly encountered in our clinic, either as an initial self-motivated visit or on consultation from another physician. The rash consists of small smooth bumps that may be skin-colored, pink
Granuloma annulare (GA) is a skin disease commonly encountered in our clinic, either as an initial self-motivated visit or on consultation from another physician. The rash consists of small smooth bumps that may be skin-colored, pink, reddish-purple, brownish-orange. The bumps may coalesce into rings with clearing in the center; that is what the descriptive annulare implies. The word granuloma refers to a type of chronic inflammation in the dermis (second layer of skin) consisting of lymphocytes and histiocytes that alters the microscopic appearance of the connective tissue.
Patients who have GA are generally aware of their rash because they can see it on their skin, but it usually doesn’t cause symptoms in localized cases. I will occasionally find previously unsuspected areas of localized GA lesions on patients during a routine skin examination. Some patients experience a more generalized form of GA and complain of a tingling or burning type of sensation in the skin. While most granulomas are superficial, it is possible to have deeper subcutaneous nodules of GA, and these may be painful if they are located on pressure-bearing points such as the elbows, knees, or hands.
GA can occur anywhere on the body skin, but it is most commonly seen on the upper and lower extremities, especially hands, feet, wrists and ankles. Face and neck involvement is uncommon. The cause is not known. An association with diabetes mellitus has been considered for decades but n