eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Granuloma Annulare: Follow-up

Author: Ruby Ghadially, MBChB, FRCP(C)Derm, Professor, Department of Dermatology, University of California, San Francisco, School of Medicine
Coauthor(s): Akos Z Szabo, MD, Resident Physician, Department of Plastic and Hand Surgery, Freiburg University Medical Center; Amit Garg, MD, Director of Clinical Elective in Dermatology, Assistant Professor, Department of Internal Medicine, Division of Dermatology, University of Massachusetts Medical School
Contributor Information and Disclosures

Updated: Aug 26, 2009

Follow-up

Complications

  • Gass et al report a 70-year-old man with disseminated granuloma annulare (GA) in a photosensitive distribution, who, after successful systemic and topical treatment, developed milia and scarring. This is purported to be the first report of scarring and milia formation after successful treatment of granuloma annulare.25

Prognosis

  • Spontaneous resolution of localized granuloma annulare has occurred within 2 years in 50% of cases, although lesions may last weeks to decades. Recurrence, often at the same site, is noted in 40% of cases.
  • Generalized granuloma annulare has a more chronic course, with rare spontaneous resolution, poor response to treatment, and frequent relapses.
  • Subcutaneous granuloma annulare lesions often spontaneously regress. Local or distant recurrences have been reported in 20-75% of cases in different studies.

Patient Education

  • Patients and families should be reassured about the typically benign nature and course of granuloma annulare.

Miscellaneous

Medicolegal Pitfalls

  • Because most cases of granuloma annulare resolve without adverse medical sequelae, the risk of medical/legal liability is minimal. Complications resulting from treatment may be a more likely cause of litigation.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.



More on Granuloma Annulare

Overview: Granuloma Annulare
Differential Diagnoses & Workup: Granuloma Annulare
Treatment & Medication: Granuloma Annulare
Follow-up: Granuloma Annulare
References
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References

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  2. Felner EI, Steinberg JB, Weinberg AG. Subcutaneous granuloma annulare: a review of 47 cases. Pediatrics. Dec 1997;100(6):965-7. [Medline].

  3. Penas PF, Jones-Caballero M, Fraga J, Sanchez-Perez J, Garcia-Diez A. Perforating granuloma annulare. Int J Dermatol. May 1997;36(5):340-8. [Medline].

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  11. Blume-Peytavi U, Zouboulis CC, Jacobi H, Scholz A, Bisson S, Orfanos CE. Successful outcome of cryosurgery in patients with granuloma annulare. Br J Dermatol. Apr 1994;130(4):494-7. [Medline].

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  24. [Guideline] Frykberg RG, Zgonis T, Armstrong DG, et al. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg. Sep-Oct 2006;45(5 Suppl):S1-66. [Medline].

  25. Gass JK, Todd PM, Rytina E. Generalized granuloma annulare in a photosensitive distribution resolving with scarring and milia formation. Clin Exp Dermatol. Jul 2009;34(5):e53-5. [Medline].

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Further Reading

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Keywords

granuloma annulare, GA, dermatosis, dermal papules, annular plaques, localized granuloma annulare, generalized granuloma annulare, subcutaneous granuloma annulare, perforating granuloma annulare, arcuate dermal erythema, actinic granuloma, AG, annular elastolytic giant cell granuloma, Miescher granuloma, type IV cell-mediated immunity, immune complex vasculitis

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Contributor Information and Disclosures

Author

Ruby Ghadially, MBChB, FRCP(C)Derm, Professor, Department of Dermatology, University of California, San Francisco, School of Medicine
Ruby Ghadially, MBChB, FRCP(C)Derm is a member of the following medical societies: American Academy of Dermatology, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Akos Z Szabo, MD, Resident Physician, Department of Plastic and Hand Surgery, Freiburg University Medical Center
Disclosure: Nothing to disclose.

Amit Garg, MD, Director of Clinical Elective in Dermatology, Assistant Professor, Department of Internal Medicine, Division of Dermatology, University of Massachusetts Medical School
Amit Garg, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Student Association/Foundation
Disclosure: Abbott Immunology Honoraria Speaking and teaching; Centocor Grant/research funds Other; RegenRx Grant/research funds Other

Medical Editor

James J Nordlund, MD, Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine
James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Rosalie Elenitsas, MD, Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System
Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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