Clinical features

Usually the lesions are asymptomatic. Sometimes there may be mild pruritus. Most often cutaneous eruptions can be seen on the lateral or dorsal surfaces of the hands and feet but can occur in any part of the body (1). Incidences of painful lesions have been recorded (2).

• There are four main types of clinical presentation with granuloma annulare (1):
  • 1. Localized form
    • make up of about 75% of all granuloma annulare cases
    • the lesions are found in the lateral or dorsal aspects of the limbs
    • lesions begins as a ring of small, firm, flesh-colored or red papules and as the disease progresses the ring of papules slowly increases from 0.5 to 5.0 cm in diameter
    • the lesions can be isolated or coalesce into a plaque
    • spontaneous resolution within two years can be seen in about 50% of the patients (1)
  • 2. Disseminated or generalized form
    • similar to the localized form but more widespread with 10 or more lesions
    • the papules may fuse together into annular plaques in the extremities, trunk or neck
    • the lesions can last up to 3 or 4 years or even more (1)
  • 3. Subcutaneous form
    • is primarily diagnosed in children 2 to 5 years old
    • asymptomatic rapidly growing subcutaneous nodules can be seen on the extremities, hands, scalp, buttocks, and pretibial and periorbital areas
    • lesions may be solitary or in clusters
    • diagnosis is made through excisional biopsy
    • lesions can resolve spontaneously or may recur after excision (1)
  • 4. Perforating form
    • is a rare disease most often seen in children and young adults
    • more common in women than in men
    • can present with localized (found on the upper limbs and pelvis) or generalized (is more common and present on the abdominal area, trunk, upper and lower limb)
    • patients maybe asymptomatic or they might present with pruritus or pain (1)

Reference:

• 1 Cyr PR. Diagnosis and Management of Granuloma Annulare. Am Fam Physician 2006;74:1729-34
• 2. Whelan JP, Zembovicz A. Case 19-2006 - A 22-Month-Old Boy with the Rapid Growth Subcutaneous Nodules. N Engl J Med. 2006;354(25):2697- 2704.