Laboratory Studies

Laboratory studies are largely noncontributory in patients with granuloma annulare (GA). With a classic history and unremarkable physical examination findings (other than the presenting lesion[s]), no additional workup is necessary.

If, however, a thorough history is not available or systemic disease is considered likely, appropriate laboratory evaluations should be performed to exclude other diagnostic possibilities. For example, in subcutaneous granuloma annulare, a CBC count, an erythrocyte sedimentation rate, and a rheumatoid factor study may assist in excluding other possible causes for nodules.

Imaging Studies

Imaging studies are not generally necessary in diagnosing granuloma annulare. However, radiographs, CT scans, or MRIs may be helpful in the evaluation of atypical subcutaneous lesions.

Radiographs of subcutaneous granuloma annulare show a nonspecific soft tissue mass without calcification. On CT scans, subcutaneous granuloma annulare appears as a poorly defined mass with variable attenuation and variable contrast enhancement. On MRIs, subcutaneous granuloma annulare appears as a mass with poorly defined margins that is limited to subcutaneous tissue. MRI findings may be suggestive of, but not diagnostic of, subcutaneous granuloma annulare.^{[13, 14]}

Procedures

Biopsy is recommended for a subcutaneous lesion and for an atypical presentation with respect to history (ie, rapid enlargement, pain) or location of lesion.

Histologic Findings

Early interstitial or incomplete granuloma annulare lesions show an interstitial pattern characterized by lymphocytes around vessels of the superficial and deep plexuses and by macrophages scattered between reticular dermal collagen bundles that are separated by mucin within which mast cells may be found. Mucin in granuloma annulare is hyaluronic acid and is visible in sections stained with hematoxylin and eosin as faintly basophilic stringy material. Its presence can be confirmed by staining with colloidal iron or Alcian blue at pH 2.5.

Fully evolved granuloma annulare lesions and deep subcutaneous granuloma annulare nodules demonstrate palisaded granulomatous dermatitis or a septal and lobular panniculitis, respectively. Macrophages surround acellular necrobiotic areas in which collagen bundles are thinned, or they sometimes have a pale, homogeneous, light-blue appearance, the latter of which is due to the presence of mucin.

In many cases of subcutaneous granuloma annulare, and in some dermal infiltrates, the centers of granulomas contain degenerated, homogeneous-appearing collagen and are deeply eosinophilic. In some sections, necrotic small vessels in the centers of palisaded foci are surrounded by nuclear dust. Presence of fibrinogen can be shown by direct immunofluorescence in the centers of palisaded granulomas. In perforating lesions, necrobiotic material is extruded through focal perforations. Epidermal hyperplasia at the edge of the perforation forms a pseudochannel communicating with an underlying necrobiotic granuloma.

Rare cases of nonnecrobiotic, sarcoidal, or tuberculoid granuloma annulare are also described.

Actinic annulare, also known as annular elastolytic giant cell granuloma, may lack the classic palisaded arrangement observed in granuloma annulare. Although elastosis is abundant in the mid dermis outside the granuloma, elastic tissue is absent from the center of the annulus. Giant cells frequently abut elastotic tissue, and phagocytosed elastotic fibers are noted in histiocytic cells at the advancing edge. Collagen has a normal appearance outside the lesion but a finely fibrillar pattern within the annulus. Mucin deposition is not increased as it is in granuloma annulare. Thus, actinic annulare can be distinguished histologically from granuloma annulare by a preponderance of giant cells in relation to elastotic tissue, by absence of mucin, and, occasionally, by absence of palisading histiocytes around granulomas.

Treatment & Management

Piette EW, Rosenbach M. Granuloma annulare: Pathogenesis, disease associations and triggers, and therapeutic options. J Am Acad Dermatol. 2016 Sep. 75 (3):467-479. [QxMD MEDLINE Link].
Piette EW, Rosenbach M. Granuloma annulare: Clinical and histologic variants, epidemiology, and genetics. J Am Acad Dermatol. 2016 Sep. 75 (3):457-465. [QxMD MEDLINE Link].
Felner EI, Steinberg JB, Weinberg AG. Subcutaneous granuloma annulare: a review of 47 cases. Pediatrics. 1997 Dec. 100(6):965-7. [QxMD MEDLINE Link].
Penas PF, Jones-Caballero M, Fraga J, Sanchez-Perez J, Garcia-Diez A. Perforating granuloma annulare. Int J Dermatol. 1997 May. 36(5):340-8. [QxMD MEDLINE Link].
Ghadially R. Granuloma annulare, actinic granuloma. Arndt K, et al, eds. Cutaneous Medicine and Surgery. WB Saunders Co; 1996. 438-443.
Mehta LR, Rose JW. Recurrent granuloma annulare during treatment with daclizumab. Mult Scler. 2009 Apr. 15(4):527-8. [QxMD MEDLINE Link].
Cornejo CM, Haun P, English J 3rd, Rosenbach M. Immune checkpoint inhibitors and the development of granulomatous reactions. J Am Acad Dermatol. 2019 Nov. 81 (5):1165-1175. [QxMD MEDLINE Link].
Fontecilla NM, Kittler NW, Lopez A, Yang C, Geskin L. Programmed cell death protein-1 inhibitor-induced granuloma annulare and hypertrophic lichen planus masquerading as squamous cell carcinoma. JAAD Case Rep. 2018 Aug. 4 (7):636-639. [QxMD MEDLINE Link].
Wu J, Kwong BY, Martires KJ, Rieger KE, Chung WH, Iyer GV, et al. Granuloma annulare associated with immune checkpoint inhibitors. J Eur Acad Dermatol Venereol. 2018 Apr. 32 (4):e124-e126. [QxMD MEDLINE Link].
Kakourou T, Psychou F, Voutetakis A, Xaidara A, Stefanaki K, Dacou-Voutetakis C. Low serum insulin values in children with multiple lesions of granuloma annulare: a prospective study. J Eur Acad Dermatol Venereol. 2005 Jan. 19(1):30-4. [QxMD MEDLINE Link].
Li A, Hogan DJ, Sanusi ID, Smoller BR. Granuloma annulare and malignant neoplasms. Am J Dermatopathol. 2003 Apr. 25(2):113-6. [QxMD MEDLINE Link].
O'Brien JP, Regan W. Actinically degenerate elastic tissue is the likely antigenic basis of actinic granuloma of the skin and of temporal arteritis. J Am Acad Dermatol. 1999 Feb. 40(2 Pt 1):214-22. [QxMD MEDLINE Link].
De Maeseneer M, Vande Walle H, Lenchik L, Machiels F, Desprechins B. Subcutaneous granuloma annulare: MR imaging findings. Skeletal Radiol. 1998 Apr. 27(4):215-7. [QxMD MEDLINE Link].
Shehan JM, El-Azhary RA. Magnetic resonance imaging features of subcutaneous granuloma annulare. Pediatr Dermatol. 2005 Jul-Aug. 22(4):377-8. [QxMD MEDLINE Link].
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. 1994 Apr. 130(4):494-7. [QxMD MEDLINE Link].
Sniezek PJ, DeBloom JR 2nd, Arpey CJ. Treatment of granuloma annulare with the 585 nm pulsed dye laser. Dermatol Surg. 2005 Oct. 31 (10):1370-3. [QxMD MEDLINE Link].
Sliger BN, Burk CJ, Alvarez-Connelly E. Treatment of granuloma annulare with the 595 nm pulsed dye laser in a pediatric patient. Pediatr Dermatol. 2008 Mar-Apr. 25 (2):196-7. [QxMD MEDLINE Link].
Liu A, Hexsel CL, Moy RL, Ozog DM. Granuloma annulare successfully treated using fractional photothermolysis with a 1,550-nm erbium-doped yttrium aluminum garnet fractionated laser. Dermatol Surg. 2011 May. 37 (5):712-5. [QxMD MEDLINE Link].
Bronfenbrener R, Ragi J, Milgraum S. Granuloma annulare treated with excimer laser. J Clin Aesthet Dermatol. 2012 Nov. 5 (11):43-5. [QxMD MEDLINE Link].
Passeron T, Fusade T, Vabres P, Bousquet-Rouaud R, Collet-Vilette AM, Dahan S, et al. Treatment of granuloma annulare with the 595-nm pulsed dye laser, a multicentre retrospective study with long-term follow-up. J Eur Acad Dermatol Venereol. 2011 Dec 21. [QxMD MEDLINE Link].
Harth W, Linse R. Topical tacrolimus in granuloma annulare and necrobiosis lipoidica. Br J Dermatol. 2004 Apr. 150(4):792-4. [QxMD MEDLINE Link].
Jain S, Stephens CJ. Successful treatment of disseminated granuloma annulare with topical tacrolimus. Br J Dermatol. 2004 May. 150(5):1042-3. [QxMD MEDLINE Link].
Rigopoulos D, Prantsidis A, Christofidou E, Ioannides D, Gregoriou S, Katsambas A. Pimecrolimus 1% cream in the treatment of disseminated granuloma annulare. Br J Dermatol. 2005 Jun. 152(6):1364-5. [QxMD MEDLINE Link].
Lopez-Navarro N, Castillo R, Gallardo MA, Alcaide A, Matilla A, Herrera E. Successful treatment of perforating granuloma annulare with 0.1% tacrolimus ointment. J Dermatolog Treat. 2008. 19 (6):376-7. [QxMD MEDLINE Link].
Grieco T, Cantisani C, Faina P, Cantoresi F, Lacobellis F, Silvestri E, et al. Tacrolimus 0.1% and granuloma annulare: description of three cases. J Eur Acad Dermatol Venereol. 2009 Dec. 23 (12):1445-6. [QxMD MEDLINE Link].
Gomez-Moyano E, Vera-Casaño A, Martinez S, Sanz A. Periorbital granuloma annulare successfully treated with tacrolimus 0.1% ointment. Int J Dermatol. 2014 Feb. 53 (2):e156-7. [QxMD MEDLINE Link].
Kuwahara RT, Naylor MF, Skinner RB. Treatment of granuloma annulare with topical 5% imiquimod cream. Pediatr Dermatol. 2003 Jan-Feb. 20(1):90. [QxMD MEDLINE Link].
Badavanis G, Monastirli A, Pasmatzi E, Tsambaos D. Successful treatment of granuloma annulare with imiquimod cream 5%: a report of four cases. Acta Derm Venereol. 2005. 85(6):547-8. [QxMD MEDLINE Link].
Errichetti E, Stinco G, Pegolo E, Patrone P. Generalized Granuloma Annulare in a Cirrhotic Patient Treated with Narrowband Ultraviolet B Therapy. Indian J Dermatol. 2016 Jan-Feb. 61 (1):127. [QxMD MEDLINE Link].
Ine K, Kabashima K, Koga C, Kobayashi M, Tokura Y, Kabashima K. Eruptive generalized granuloma annulare presenting with numerous micropapules. Int J Dermatol. 2010 Jan. 49 (1):104-5. [QxMD MEDLINE Link].
Inui S, Nishida Y, Itami S, Katayama I. Disseminated granuloma annulare responsive to narrowband ultraviolet B therapy. J Am Acad Dermatol. 2005 Sep. 53 (3):533-4. [QxMD MEDLINE Link].
Samson Yashar S, Gielczyk R, Scherschun L, Lim HW. Narrow-band ultraviolet B treatment for vitiligo, pruritus, and inflammatory dermatoses. Photodermatol Photoimmunol Photomed. 2003 Aug. 19 (4):164-8. [QxMD MEDLINE Link].
Yong A, Chong WS, Pan JY. Disseminated granuloma annulare responding to narrowband UVB phototherapy. Photodermatol Photoimmunol Photomed. 2016 Mar. 32 (2):107-9. [QxMD MEDLINE Link].
Mikami E, Yanase M, Ito M, Kanzaki A, Saeki H. Generalized granuloma annulare successfully treated with narrowband ultraviolet B and anti-hepatitis C virus therapy. J Dermatol. 2016 Feb 19. [QxMD MEDLINE Link].
Pavlovsky M, Samuelov L, Sprecher E, Matz H. NB-UVB phototherapy for generalized granuloma annulare. Dermatol Ther. 2015 Dec 2. [QxMD MEDLINE Link].
Kerker BJ, Huang CP, Morison WL. Photochemotherapy of generalized granuloma annulare. Arch Dermatol. 1990 Mar. 126(3):359-61. [QxMD MEDLINE Link].
Batchelor R, Clark S. Clearance of generalized papular umbilicated granuloma annulare in a child with bath PUVA therapy. Pediatr Dermatol. 2006 Jan-Feb. 23 (1):72-4. [QxMD MEDLINE Link].
Grundmann-Kollmann M, Ochsendorf FR, Zollner TM, Tegeder I, Kaufmann R, Podda M. Cream psoralen plus ultraviolet A therapy for granuloma annulare. Br J Dermatol. 2001 May. 144 (5):996-9. [QxMD MEDLINE Link].
Browne F, Turner D, Goulden V. Psoralen and ultraviolet A in the treatment of granuloma annulare. Photodermatol Photoimmunol Photomed. 2011 Apr. 27 (2):81-4. [QxMD MEDLINE Link].
Looney M, Smith KM. Isotretinoin in the treatment of granuloma annulare. Ann Pharmacother. 2004 Mar. 38(3):494-7. [QxMD MEDLINE Link].
Schleicher SM, Milstein HJ. Resolution of disseminated granuloma annulare following isotretinoin therapy. Cutis. 1985 Aug. 36 (2):147-8. [QxMD MEDLINE Link].
Schleicher SM, Milstein HJ, Lim SJ, Stanton CD. Resolution of disseminated granuloma annulare with isotretinoin. Int J Dermatol. 1992 May. 31 (5):371-2. [QxMD MEDLINE Link].
Tang WY, Chong LY, Lo KK. Resolution of generalized granuloma annulare with isotretinoin therapy. Int J Dermatol. 1996 Jun. 35 (6):455-6. [QxMD MEDLINE Link].
Sahin MT, Türel-Ermertcan A, Oztürkcan S, Türkdogan P. Generalized granuloma annulare in a patient with type II diabetes mellitus: successful treatment with isotretinoin. J Eur Acad Dermatol Venereol. 2006 Jan. 20 (1):111-4. [QxMD MEDLINE Link].
Pasmatzi E, Georgiou S, Monastirli A, Tsambaos D. Temporary remission of disseminated granuloma annulare under oral isotretinoin therapy. Int J Dermatol. 2005 Feb. 44 (2):169-71. [QxMD MEDLINE Link].
Adams DC, Hogan DJ. Improvement of chronic generalized granuloma annulare with isotretinoin. Arch Dermatol. 2002 Nov. 138 (11):1518-9. [QxMD MEDLINE Link].
Grewal SK, Rubin C, Rosenbach M. Antimalarial therapy for granuloma annulare: Results of a retrospective analysis. J Am Acad Dermatol. 2017 Apr. 76 (4):765-767. [QxMD MEDLINE Link].
Cannistraci C, Lesnoni La Parola I, Falchi M, Picardo M. Treatment of generalized granuloma annulare with hydroxychloroquine. Dermatology. 2005. 211 (2):167-8. [QxMD MEDLINE Link].
Simon M Jr, von den Driesch P. Antimalarials for control of disseminated granuloma annulare in children. J Am Acad Dermatol. 1994 Dec. 31 (6):1064-5. [QxMD MEDLINE Link].
Piaserico S, Zattra E, Linder D, Peserico A. Generalized granuloma annulare treated with methylaminolevulinate photodynamic therapy. Dermatology. 2009. 218(3):282-4. [QxMD MEDLINE Link].
Weisenseel P, Kuznetsov AV, Molin S, Ruzicka T, Berking C, Prinz JC. Photodynamic therapy for granuloma annulare: more than a shot in the dark. Dermatology. 2008. 217(4):329-32. [QxMD MEDLINE Link].
Calzavara-Pinton PG, Rossi MT, Sala R, Italian Group For Photodynamic Therapy. A retrospective analysis of real-life practice of off-label photodynamic therapy using methyl aminolevulinate (MAL-PDT) in 20 Italian dermatology departments. Part 2: oncologic and infectious indications. Photochem Photobiol Sci. 2013 Jan. 12 (1):158-65. [QxMD MEDLINE Link].
Marcus DV, Mahmoud BH, Hamzavi IH. Granuloma annulare treated with rifampin, ofloxacin, and minocycline combination therapy. Arch Dermatol. 2009 Jul. 145(7):787-9. [QxMD MEDLINE Link].
Garg S, Baveja S. Monthly rifampicin, ofloxacin, and minocycline therapy for generalized and localized granuloma annulare. Indian J Dermatol Venereol Leprol. 2015 Jan-Feb. 81 (1):35-9. [QxMD MEDLINE Link].
Steiner A, Pehamberger H, Wolff K. Sulfone treatment of granuloma annulare. J Am Acad Dermatol. 1985 Dec. 13 (6):1004-8. [QxMD MEDLINE Link].
Czarnecki DB, Gin D. The response of generalized granuloma annulare to dapsone. Acta Derm Venereol. 1986. 66 (1):82-4. [QxMD MEDLINE Link].
Wolf F, Grezard P, Berard F, Clavel G, Perrot H. Generalized granuloma annulare and hepatitis B vaccination. Eur J Dermatol. 1998 Sep. 8 (6):435-6. [QxMD MEDLINE Link].
Saied N, Schwartz RA, Estes SA. Treatment of generalized granuloma annulare with dapsone. Arch Dermatol. 1980 Dec. 116 (12):1345-6. [QxMD MEDLINE Link].
Visconti MJ, Ashack KA, Ashack RJ. Granuloma annulare: strengthening potential associations and pentoxifylline as a therapeutic option. J Dermatolog Treat. 2019 Sep 10. 1-2. [QxMD MEDLINE Link].
Wong GN, Wee E, Tam M, Kelly R. Pentoxifylline as a treatment for granuloma annulare. Australas J Dermatol. 2019 Nov. 60 (4):328-331. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Shupack J, Siu K. Resolving granuloma annulare with etanercept. Arch Dermatol. 2006 Mar. 142 (3):394-5. [QxMD MEDLINE Link].
Kreuter A, Altmeyer P, Gambichler T. Failure of etanercept therapy in disseminated granuloma annulare. Arch Dermatol. 2006 Sep. 142 (9):1236-7; author reply 1237. [QxMD MEDLINE Link].
Antoñanzas J, Rodríguez-Garijo N, Tomás-Velázquez A, Estenaga A, Andrés-Ramos I, España Alonso A. Treatment of recalcitrant reactive granulomatous dermatitis: Granuloma annulare subtype with etanercept. Dermatol Ther. 2020 Jul 26. e14081. [QxMD MEDLINE Link].
Murdaca G, Negrini S, Magnani O, Penza E, Pellecchio M, Gulli R, et al. Update upon efficacy and safety of etanercept for the treatment of spondyloarthritis and juvenile idiopathic arthritis. Mod Rheumatol. 2018 May. 28 (3):417-431. [QxMD MEDLINE Link].
Hertl MS, Haendle I, Schuler G, Hertl M. Rapid improvement of recalcitrant disseminated granuloma annulare upon treatment with the tumour necrosis factor-alpha inhibitor, infliximab. Br J Dermatol. 2005 Mar. 152 (3):552-5. [QxMD MEDLINE Link].
Murdaca G, Colombo BM, Barabino G, Caiti M, Cagnati P, Puppo F. Anti-tumor necrosis factor-α treatment with infliximab for disseminated granuloma annulare. Am J Clin Dermatol. 2010 Dec 1. 11 (6):437-9. [QxMD MEDLINE Link].
Amy de la Breteque M, Saussine A, Rybojad M, Kramkimel N, Vignon Pennamen MD, Bagot M, et al. Infliximab in recalcitrant granuloma annulare. Int J Dermatol. 2016 Feb. 55 (2):220-2. [QxMD MEDLINE Link].
Rosmarin D, LaRaia A, Schlauder S, Gottlieb AB. Successful treatment of disseminated granuloma annulare with adalimumab. J Drugs Dermatol. 2009 Feb. 8(2):169-71. [QxMD MEDLINE Link].
Torres T, Pinto Almeida T, Alves R, Sanches M, Selores M. Treatment of recalcitrant generalized granuloma annulare with adalimumab. J Drugs Dermatol. 2011 Dec. 10(12):1466-8. [QxMD MEDLINE Link].
Min MS, Lebwohl M. Treatment of recalcitrant granuloma annulare (GA) with adalimumab: A single-center, observational study. J Am Acad Dermatol. 2016 Jan. 74 (1):127-33. [QxMD MEDLINE Link].
Mahmood T, Mansouri B, Menter A. Successful treatment of generalized granuloma annulare with adalimumab. Clin Exp Dermatol. 2015 Jul. 40 (5):537-9. [QxMD MEDLINE Link].
Werchau S, Enk A, Hartmann M. Generalized interstitial granuloma annulare--response to adalimumab. Int J Dermatol. 2010 Apr. 49 (4):457-60. [QxMD MEDLINE Link].
Fässler M, Schlapbach C. Granuloma annulare arising under systemic psoriasis therapy successfully treated with adalimumab. JAAD Case Rep. 2020 Sep. 6 (9):832-834. [QxMD MEDLINE Link].
Wang A, Singh K, Ibrahim W, King B, Damsky W. The Promise of JAK Inhibitors for Treatment of Sarcoidosis and Other Inflammatory Disorders with Macrophage Activation: A Review of the Literature. Yale J Biol Med. 2020 Mar. 93 (1):187-195. [QxMD MEDLINE Link].
Damsky W, Singh K, Galan A, King B. Treatment of necrobiosis lipoidica with combination Janus kinase inhibition and intralesional corticosteroid. JAAD Case Rep. 2020 Feb. 6 (2):133-135. [QxMD MEDLINE Link].
Damsky W, Thakral D, McGeary MK, Leventhal J, Galan A, King B. Janus kinase inhibition induces disease remission in cutaneous sarcoidosis and granuloma annulare. J Am Acad Dermatol. 2020 Mar. 82 (3):612-621. [QxMD MEDLINE Link].
Blum S, Altman D. Treatment of generalized granuloma annulare with apremilast: A report of 2 cases. JAAD Case Rep. 2019 Nov. 5 (11):976-978. [QxMD MEDLINE Link].
Bishnoi A, Raj D, Vinay K, Dogra S. Refractory Generalized Granuloma Annulare Treated With Oral Apremilast. JAMA Dermatol. 2019 Aug 21. [QxMD MEDLINE Link].
Gass JK, Todd PM, Rytina E. Generalized granuloma annulare in a photosensitive distribution resolving with scarring and milia formation. Clin Exp Dermatol. 2009 Jul. 34(5):e53-5. [QxMD MEDLINE Link].

Media Gallery

Granuloma annulare. By Mierlo at English Wikipedia - Transferred from en.wikipedia to Commons by Stevenfruitsmaak using CommonsHelper., Public Domain, https://commons.wikimedia.org/w/index.php?curid=4560836.

of 1

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Akos Z Szabo, MD Resident Physician, Department of Obstetrics and Gynecology, University of Heidelberg Medical Center, Germany

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.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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

Granuloma Annulare Workup

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

References

Tables

Contributor Information and Disclosures

What would you like to print?