Granuloma anulare

Last Updated: 2021-12-20

Author(s): Anzengruber F., Navarini A.

ICD11: EE80.0

  • Colcott-Fox, 1895
  • Radcliffe-Crocker, 1903

Granuloma annulare

Granulomatous, benign annular papules and plaques.

  • Women > men
  • Especially at a young age (children, teenagers)

  • Plaque-type granuloma anulare
  • Granuloma anulare perforans
  • Granuloma anulare subcutaneum
  • Erythematous granuloma anulare
  • Granuloma anulare disseminatum
  • Granuloma anulare giganteum
  • Granulomatosis disciformis chronica et progressiva (Miescher's granuloma)

  • Polyetiological
    • Genetics
    • Trauma
      • Ictus reactions
    • Infections
    • Autothyroidism
    • Diabetes mellitus
    • Too intensive vitamin D3 therapy (granuloma anulare vigantolicum)

  • Mostly solitary, but also occasionally disseminated (granuloma anulare disseminatum) whitish to skin-coloured, annular, anullar papules and plaques
  • Granuloma anulare giganteum: With extensive spread (rarely up to 10 cm)
  • Granuloma anulare perforans: central umbilication with crusting

  • Clinical image
  • Biopsy
  • In case of ↑ size or dissemination
    • (blood glucose daily profile, glucose load test)
    • X-ray chest
    • Focus search

Acres, backs of hands and feet, backs of fingers, sides of joints

Often lasting for months or years, then often spontaneous regression.

Children:

  • Mostly spontaneous remission
  • If necessary, occlusive topical steroids

Dermocorticoids

  • Mometasone fuorate cream/solution/ointment
  • Clobetasol cream/ointment
  • Kenacort-A 10 /40 mg injection suspension
  • Cryosurgery with liquid nitrogen

Radiation therapy

  • Local PUVA cream therapy

Systemic therapy

  • Hydroxychloroquine p.o. initially 400 mg daily for 4-8 weeks, then 200 mg 1x daily

In case of generalised infestation

  • Acitretin p.o
    • Initial:0.5 mg/kg bw 1x daily
    • Maintenance dose: 0.1-0.2 mg/kg bw 1x daily
  • Dapsone p.o. 100-200 mg daily
    • No preparations are currently approved in Switzerland
    • Before administration: exclusion of glucose-6-phosphate dehydrogenase deficiency
    • Met-Hb: should be checked 2 weeks and 6 weeks after starting therapy

  1. Schulze-Dirks A, Petzold D. Granuloma anulare disseminatum - erfolgreiche Therapie mit Fumarsäureester. Der Hautarzt 2001;52:228-30.
  2. Jantke ME, Bertsch HP, Schön MP, Fuchs T. Therapie des Granuloma anulare disseminatum mit Anthralin. Hautarzt 2011;62:935-9.
  3. Lebwohl, Mark. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Elsevier, 2014. Print.