Granuloma annulare

Last Updated: 2020-11-19

Author(s): -

  • Colcott-Fox 1895
  • Radcliffe-Crocker 1903

Granuloma annulare

Granulomatous, benign annular papules and plaques.

  • Women > Men
  • Especially at a young age (children, teenagers)
  • Granuloma annulare type-plates
  • Granuloma annulare perforans
  • Subcutaneous granuloma annulare

  • Erythematöses Granuloma annulare

  • Granuloma annulare disseminatum

  • Granuloma annulare giganteum

  • Granulomatosis disciformis chronica et progressiva (Miescher`s Granulom).

  • Polyaetiological 
    • Genetics
    • Traumas
      • Ictal reactions
    • Infections
    • Autothyroidides
    • Diabetes mellitus
    • Vitamin D3 therapy (granuloma anulare vigantolicum).
  • Localization Mostly solitary, but also occasionally disseminated (granuloma anulare disseminatum) whitish to skin-colored, annular, anular papules and plaques.
  • Granuloma anulare giganteum: when spreading over a large area (rarely up to 10 cm)

  • Granuloma anulare perforans: central umbilical cord with crust formation.

  • Clinical image
  • Biopsy
  • With increasing size or dissemination
    • (blood glucose daily profile, glucose load test)
    • X-ray chest
    • Focus search

Whole body possible. Preferably on acra, backs of hands and feet, backs of fingers, joint extension sides.

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


  • Usually, spontaneous remission occurs
  • Possibly occlusively topical steroids



  • Mometasone furoate (Elocom®) cream/solution/ointment
  • Clobetasol (Dermovate®) Cream/Ointment

  • Kenacort-A® 10 /40 mg injection suspension
  • Cryosurgery with liquid nitrogen


Radiation therapy

  • Local PUVA cream therapy


Systemic Therapy

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


·         For generalized infestation


  • Fumaderm Tablet


  • Acitretin (Neotigason®) p.o.
  • Initial: 0,5 mg/ kg bw 1x daily
  • Maintenance dose: 0.1-0.2 mg/ kg bw 1x daily dosage


  • Dapson p.o. 100-200 mg daily
  • No drugs are currently approved in Switzerland and can be imported by international pharmacies, but patients usually have to bear the costs themselves.

  • Before administration: Exclusion of glucose-6-phosphate dehydrogenase deficiency (see drug information on Dapson).

  • Met-Hb: should be checked 2 weeks and 6 weeks after the start of 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.