Granuloma Annulare

We present a case of a 77-year-old, diabetic male with a 20-year history of a migratory erythematous, asymptomatic, generalized, nonscaly, and nonitchy rash that started over the dorsum of his left hand. On examination, there were multiple annular erythematous plaques, distributed symmetrically and diffusely over his torso and arms, with central clearing and no scales. A punch biopsy of the skin helped us to arrive at the diagnosis of a generalized granuloma annulare (GA). GA is a benign, self-limiting skin condition of unknown etiology that is often asymptomatic. The cause of this condition is unknown, but it has been associated with diabetes mellitus, infections such as HIV, and malignancies such as lymphoma. These lesions typically start as a ring of flesh-colored papules that slowly progress with central clearing. Lack of symptoms, scaling, or associated vesicles helps to differentiate GA from other skin conditions such as tinea corporis, pityriasis rosea, psoriasis, or erythema annulare centrifugum. Treatment is often not needed as the majority of these lesions are self-resolving within 2 years. Treatment may be pursued for cosmetic reasons. Available options include high-dose steroid creams, PUVA, cryotherapy, or drugs such as niacinamide, infliximab, Dapsone, and topical calcineurin inhibitors.