Last updated:
7/18/2025
Years published: 1987, 1989, 1997, 2003, 2025
NORD gratefully acknowledges Gioconda Alyea, MD (FMG), MS, National Organization for Rare Disorders, for assistance in the preparation of this report.
Granuloma annulare (GA) is a non-contagious skin condition characterized by round or ring-shaped red spots or bumps on the skin. These bumps can be pink, brown, or skin-colored. They often appear on the hands, feet, elbows, or knees. They sometimes itch but usually do not cause pain.1,2,3
There are three main types of GA: localized GA, the most common type of GA, subcutaneous GA and the less common form, generalized GA.1 Other types of GA include perforating GA and patch variant GA.
GA is generally not harmful or cancerous (benign), but it can sometimes last a long time or spread across the body.3
The cause of GA is often unknown. Sometimes GA appears after trauma on the skin, bug bites, or in areas of the body exposed to the sun. GA can often be diagnosed by looking at the skin. In some people, a small piece of skin might be removed (a biopsy) and examined under a microscope to confirm the diagnosis.1
Localized GA is treated with steroids creams or ointments. In some people, subcutaneous GA may be treated with surgery by removing the lesions. Generalized GA is more difficult to treat. Treatment options include topical and intralesional steroids, topical immunomodulators like tacrolimus, antimicrobials, phototherapy, TNF-alpha inhibitors and oral vitamin E.2
Granuloma annulare (GA) is a skin condition characterized by its ring-shaped (annular) pattern, hence, the term “annulare”. The affected areas are typically made up of small, firm bumps (papules or nodules), which are arranged in rings or arcs on the skin.3,4,5
In lighter skin, these bumps often appear pink or red. On darker skin tones, the color may range from pink or red to shades of brown. The bumps are usually flesh-colored, reddish, or slightly yellow.
Granuloma annulare can appear anywhere on the body but most often affects the fingers, hands and feet. Other possible locations include the forehead, neck and abdomen. In many people, the condition appears on both sides of the body in a symmetrical pattern.
There are five subtypes of GA, each with distinct features. While they differ in appearance and location, all forms share the characteristic of raised, firm bumps on the skin.3,4,5
The GA subtypes include: 3,4,5
Localized granuloma annulare often resolves on its own without treatment which is called spontaneous remission. In fact, about half of people with the localized form will see their symptoms disappear within two years. However, certain subtypes, particularly generalized GA, can return (recur) despite treatment.3,4
The cause of granuloma annulare (GA) is still unknown. It’s considered a skin reaction pattern that may be triggered by many different factors, but no single cause has been clearly proven. Most people with GA are otherwise healthy.3,4
Over the years, several potential triggers have been suggested including:3,4
Some long-term health issues are more common in people with GA. These include:3,4
Some case reports have noted GA in people with blood cancers (like leukemia or lymphoma) or solid tumors (like breast or lung cancer) but large-scale studies have not confirmed there is a strong connection. However, in older people with GA with widespread or unusual GA, doctors may consider evaluating for underlying cancer, especially if the skin condition does not improve with standard treatments.3,4
There have been reports of GA running in families, including in identical twins and siblings. Certain genetic markers (called human leukocyte antigens (HLA), which are proteins found on the surface of most cells in the body and have a role in the immune system by helping it distinguish between cells that belong in the body and those that are foreign) have been found more often in people with GA, suggesting that some cases may have a genetic component.7
There are two main theories that try to explain how the GA lesion develop:3,7
Granuloma annulare (GA) is a relatively rare skin condition, affecting about 0.04% to 0.06% of people in the United States, translating to approximately 38 to 58 per 100,000 people. According to a 2021 study that examined over 29,000 patients, GA is most often diagnosed in people in their forties. It appears more frequently in females than in males, with females about three times more likely to develop it. It also seems to be more common in Caucasians. More research is needed to better understand why GA affects some populations more than others.6
Diagnosing granuloma annulare (GA) involves both a careful examination of the skin and, in many people, a skin biopsy to confirm the diagnosis.3,8
During the clinical exam, the doctor will examine the lesions in the skin. GA often appears as smooth, raised bumps arranged in a ring or circular pattern, which may be skin-colored, pink, or slightly purple. These spots are usually not painful or itchy, but if they appear suddenly or spread widely, further investigation is often needed.
The skin biopsy involves taking a sample of the affected skin with a procedure called a biopsy. This is done under local anesthesia. The sample is then examined under a microscope. Doctors look for specific patterns that are typical of GA:3,8
Treatment for granuloma annulare (GA) varies depending on the form and severity of the condition. Although GA often resolves on its own, especially the localized forms, treatment may be pursued to accelerate healing, manage discomfort, or address cosmetic concerns. Medical therapies aim either to reduce inflammation, modulate the immune response, or physically remove the lesions. The choice of treatment depends on the type of GA: localized, subcutaneous, or generalized.3,7
Localized granuloma annulare
Localized GA is the most common and least aggressive type. Many people with this form do not have any symptoms and the lesions can spontaneously disappear without any treatment. In such cases, reassurance and observation may be all that is needed.3,7
However, if treatment is desired due to discomfort or cosmetic reasons, topical steroids (creams of ointments corticoids) are typically the first option. These may be applied directly to the affected area, with or without occlusion (covering the area to improve absorption), usually over four to six weeks. In cases where topical treatment is insufficient, corticoids may be injected directly into the lesion (intralesional corticoids).3,7
For lesions that do not improve with corticoids, other options may be considered: 3,7
Subcutaneous granuloma annulare
Subcutaneous GA forms deeper lumps under the skin, often without visible surface changes. These nodules are generally benign but may be surgically removed if they cause pain, pressure, or cosmetic concern. Simple excision is often effective and recurrence at the removal site is uncommon.3
Generalized granuloma annulare
Generalized GA is a more widespread and persistent form of the disease. It can be more cosmetically distressing and harder to treat. Several treatments are available, but not all people have improved.
Ultraviolet light therapies are commonly used and considered relatively safe for long-term management. Narrowband ultraviolet B (UVB) phototherapy is often the first-line option due to its efficacy and low risk. Another option, PUVA (psoralen plus ultraviolet A), involves taking a photosensitizing medication before UVA exposure, though it carries a higher risk of side effects including long-term skin damage or malignancy.3,7
Other treatments can be used if skin-directed therapies are insufficient including:
There is no FDA-approved standard treatment for GA. Because it has an unpredictable nature and sometimes spontaneous remission (in many cases of the localized form), it may not need to be treated. The decision to treat depends on the extent of the disease, patient preference, response to previous therapies and tolerance for risk. More research is needed to better understand the causes and optimal treatments for each form of GA.3,7
Information on current clinical trials is posted on the Internet at https://clinicaltrials.gov/. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Toll-free: (800) 411-1222
TTY: (866) 411-1010
Email: [email protected]
Some current clinical trials also are posted on the following page on the NORD website:
https://rarediseases.org/living-with-a-rare-disease/find-clinical-trials/
For information about clinical trials sponsored by private sources, contact:
https://www.centerwatch.com/
For information about clinical trials conducted in Europe, contact:
https://www.clinicaltrialsregister.eu/
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