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Annulare and Pyogenic Granuloma Workup

  • Author: Richard Lichenstein, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
Updated: Jul 14, 2016

Laboratory Studies

Laboratory studies may be helpful if the diagnosis of granuloma annulare cannot be ruled out with a complete history emphasizing issues such as diet, weight loss, and/or fever. If an accurate history is unobtainable, a CBC and erythrocyte sedimentation rate (ESR) should be obtained.

No laboratory studies are needed to make the diagnosis of pyogenic granuloma. CBC, human chorionic gonadotropin (HCG), HIV, and biochemical profiles are needed only if there is concern for other etiologies.

Check blood glucose level if there is concern of diabetes mellitus and granuloma annulare.

Check rheumatoid factor if symptoms of rheumatoid arthritis are present.


Imaging Studies

Granuloma annulare

Radiographs are not necessary for diagnosis of granuloma annulare but may be helpful if other problems are suspected.

In granuloma annulare, the lesion is soft tissue mass without any calcification or bony involvement.

Pyogenic granuloma

Imaging studies are not useful in pyogenic granuloma.



Skin biopsy

To obtain a specimen, a 22- or 24-gauge needle may be gently passed tangentially just below the superficial capsular layer of the lesion, then flushed with saline to yield a small but adequate specimen.

Skin biopsy is diagnostic for granuloma annulare. Because the lesions regress, biopsy is needed only when a definitive diagnosis is required.

Skin biopsy is also diagnostic for pyogenic granuloma.

Contributor Information and Disclosures

Richard Lichenstein, MD Professor, Pediatric Emergency Department, University of Maryland School of Medicine

Richard Lichenstein, MD is a member of the following medical societies: American Medical Association, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Steven C Dronen, MD, FAAEM Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Edward A Michelson, MD Associate Professor, Program Director, Department of Emergency Medicine, University Hospital Health Systems of Cleveland

Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.


Mark W Fourre, MD Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine; Program Director, Department of Emergency Medicine, Maine Medical Center

Disclosure: Nothing to disclose.

  1. Kamal R, Dahiya P, Puri A. Oral pyogenic granuloma: Various concepts of etiopathogenesis. J Oral Maxillofac Pathol. 2012 Jan. 16(1):79-82. [Medline]. [Full Text].

  2. Krishnapillai R, Punnoose K, Angadi PV, Koneru A. Oral pyogenic granuloma-a review of 215 cases in a South Indian Teaching Hospital, Karnataka, over a period of 20 years. Oral Maxillofac Surg. 2012 Jan 26. [Medline].

  3. Spicuzza L, Salafia S, Capizzi A, Vitaliti G, Rotolo N, Leonardi S, et al. Granuloma annulare as first clinical manifestation of diabetes mellitus in children: a case report. Diabetes Res Clin Pract. 2012 Mar. 95(3):e55-7. [Medline].

  4. Ziemer M, Grabner T, Eisendle K, Baltaci M, Zelger B. Granuloma annulare - a manifestation of infection with Borrelia?. J Cutan Pathol. 2008 Jun 18. [Medline].

  5. Scott PL, Motaparthi K, Krishnan B, Hsu S. Pyogenic granuloma-like Kaposi sarcoma: a diagnostic pitfall. Dermatol Online J. 2012 Mar 15. 18(3):4. [Medline].

  6. Sills ES, Zegarelli DJ, Hoschander MM, Strider WE. Clinical diagnosis and management of hormonally responsive oral pregnancy tumor (pyogenic granuloma). J Reprod Med. 1996 Jul. 41(7):467-70. [Medline].

  7. Thornsberry LA, English JC 3rd. Etiology, diagnosis, and therapeutic management of granuloma annulare: an update. Am J Clin Dermatol. 2013 Aug. 14(4):279-90. [Medline].

  8. Lee J, Sinno H, Tahiri Y, Gilardino MS. Treatment options for cutaneous pyogenic granulomas: a review. J Plast Reconstr Aesthet Surg. 2011 Sep. 64(9):1216-20. [Medline].

  9. Wine Lee L, Goff KL, Lam JM, Low DW, Yan AC, Castelo-Soccio L. Treatment of pediatric pyogenic granulomas using β-adrenergic receptor antagonists. Pediatr Dermatol. 2014 Mar-Apr. 31 (2):203-7. [Medline].

  10. Pagliai KA, Cohen BA. Pyogenic granuloma in children. Pediatr Dermatol. 2004 Jan-Feb. 21(1):10-3. [Medline].

  11. Looney M, Smith KM. Isotretinoin in the treatment of granuloma annulare. Ann Pharmacother. 2004 Mar. 38(3):494-7. [Medline].

  12. Weber HO, Borelli C, Rocken M, Schaller M. Treatment of disseminated granuloma annulare with low-dose fumaric acid. Acta Derm Venereol. 2009. 89(3):295-8. [Medline].

  13. Werchau S, Enk A, Hartmann M. Generalized interstitial granuloma annulare--response to adalimumab. Int J Dermatol. 2010 Apr. 49(4):457-60. [Medline].

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