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Genetic and Rare Diseases Information Center (GARD)

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Granuloma annulare


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Your Question

I have disseminated granuloma annular. Will this condition cause my tissue to die? Have there been reports of granuloma annular following ingestion of allopurinol?

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

Have there been reports of granuloma annular following ingestion of allopurinol?

Yes. Granuloma annular has been reported to follow ingestion of allopurinol. It has also been reported to follow insects bites, sun exposure, tuberculin skin tests, trauma, and viral infections (including, Epstein-Barr, HIV hepatitis C, and herpes zoster). It remains unknown exactly how and why granuloma annular is triggered. Whatever the cause, it is clear that the condition causes our body’s immune system to react, resulting in inflammation.[1]
Last updated: 1/7/2009

I have disseminated granuloma annular. Will this condition cause my tissue to die?

On a cell and tissue level, it is suspected that in granuloma annular, inflammation surrounds blood vessels and changes collagen and elastic tissues.[1] These changes cause the characteristic skin lesions. As the condition progresses the skin lesions may slowly increase in size, however with time many cases of granuloma annular spontaneously resolve.[1] As a result the condition is often considered to be a benign, self-limiting condition, and usually does not cause any symptoms other than mild itching. However, for some it it can take many years for disseminated lesions to resolve, in other cases the granuloma annular never fully resolves, and these lesions can recur.[1]
Last updated: 1/7/2009

How might granuloma annulare be treated?

Granuloma annulare is difficult to treat and there are a limited number of clinical trials to reliably inform patients and physicians of the treatment options. Fortunately, most lesions of granuloma annulare disappear with no treatment within two years. Sometimes, however, the rings can remain for many years.[2] Very strong topical steroid creams or ointments may be used to speed the disappearance of the lesions. Injections of steroids directly into the rings may also be effective. Some physicians may choose to freeze the lesions with liquid nitrogen. In severe cases, ultraviolet light therapy (PUVA) or oral medications may be needed.[3]

Other treatments that have been tried include [2][1]:

  • Dapsone (a type of antibiotic) for widespread granuloma annulare 
  • Etretinate (not available in the US) 
  • Chloroquine 
  • Cyclosporine 
  • Niacinamide 
  • Oral psoralen 
  • Vitamin E combined with a 5-lipoxygenase inhibitor 
  • Fumaric acid esters 
  • Topical tacrolimus 
  • Pimecrolimus 
  • Infliximab (in a patient with disseminated granuloma annulare that did not respond to other treatments)

A review article titled, 'Diagnosis and Management of Granuloma Annulare' provides additional information on treatment options for granuloma annulare: http://www.aafp.org/afp/20061115/1729.html 

Also, an article from Medscape Reference provides information on treatment for granuloma annulare at the following link. You may need to register to view the article, but registration is free.
http://emedicine.medscape.com/article/1123031-overview

Last updated: 5/31/2013

Are there any clinical trials investigating new treatments for granuloma annulare?

While there are no current studies specifically investigating treatments for granuloma annulare, there are two studies which have recently been completed. Through these studies, the researchers may have discovered information pertinent to your particular case. Further information about these studies can be accessed through ClinicalTrials.gov, a database developed by the U.S. National Institutes of Health, through the National Library of Medicine to provide patients, family members, and members of the public with current information on clinical research studies. To read about these studies, visit the hyperlinks below. After you click on the study, review its information to determine if it provides you with useful information. Check this site often for regular updates.
Ultraviolet B (UVB) Light Therapy in the Treatment of Skin Conditions With Altered Dermal Matrix
Granuloma Annulare Treated With Rifampin, Ofloxacin, and Minocycline Combination Therapy

To locate information resulting from these completed studies you can either e-mail or call the National Library of Medicine (NLM) Customer Service. Include the title of the study, the study ID number, and the NLM Identifier, and a librarian at NLM can assist you in searching the medical literature for published results on the completed clinical trial.

National Library of Medicine Customer Service
Toll-free: 888-346-3656
E-mail: custserv@nlm.nih.gov

In addition, there is a study, entitled 'Evaluation and Treatment of Patients Who Have Skin Diseases' which may be of interest to you. Patients enrolled in this protocol will be evaluated and treated according to generally available, standard procedures, and therapeutic modalities. Samples of blood and skin will be studied by routine and specialized investigative methods to establish these patients' diagnosis, response to treatment, and/or disease progression. To view information about this clinical trial, click on the link above and review its eligibility criteria to determine its appropriateness.

You can also contact the Patient Recruitment and Public Liaison Office at the National Institutes of Health (NIH). We recommend calling the toll-free number listed below to speak with a specialist, who can help you determine if there are any other trials which would be appropriate for an individual with granuloma annulare.

Patient Recruitment and Public Liaison Office
NIH Clinical Center
Bethesda, Maryland 20892-2655
Toll-free: 800-411-1222
Fax: 301-480-9793
Email: prpl@mail.cc.nih.gov
Web site: "http://clinicalcenter.nih.gov/

Last updated: 5/31/2013

References
  • Freedberg, Irwin, et. al.. Fitzpatrick's Dermatology in General Medicine, 6th edition. United States: The McGraw-Hill Companies, Inc.; 2003;
  • PR Cyr. Diagnosis and Management of Granuloma Annulare. American Family Physician. 2006; 74 (10): 1729-1734..
  • Berman K. Granuloma Annulare. MedlinePlus. July 11, 2012; http://www.nlm.nih.gov/medlineplus/ency/article/000833.htm. Accessed 5/31/2013.