Granuloma Annulare:
Teen information

If the diagnosis of granuloma annulare is not obvious, the doctor may want to perform a skin biopsy. The procedure involves:

1. Numbing the skin with an injectable anesthetic.
2. Sampling a small piece of skin by using a flexible razor blade, a scalpel, or a tiny cookie cutter (called a "punch biopsy"). If a punch biopsy is taken, a stitch (suture) or two may be placed and will need to be removed 6–14 days later.
3. Having the skin sample examined under the microscope by a specially trained physician (dermatopathologist).

Once the diagnosis of granuloma annulare is confirmed, you and your physician may decide not to treat it. Up to 70% of cases of granuloma annulare go away by themselves (spontaneous resolution) within 2 years, even without treatment. However, up to 40% of people may experience a return of the lesions (recurrence), usually at the same sites of the original rash.

If the lesions of granuloma annulare are uncomfortable or unsightly, the physician may recommend one of the following:

• A prescription-strength steroid or cortisone cream
• Steroid injections directly into the lesions
• Freezing with liquid nitrogen (cryosurgery)
• Non-steroid topical anti-inflammatory creams such as tacrolimus or pimecrolimus
• Treatment with carbon dioxide laser

Generalized granuloma annulare is more stubborn, with fewer cases of spontaneous resolution and more recurrences. In addition, more aggressive medications may be used:

• Oral steroids, such as prednisone
• Oral retinoids, such as isotretinoin (Accutane®)
• Ultraviolet light
• Other oral medications such as potassium iodide, dapsone, nicotinamide, pentoxifylline, hydroxychloroquine, or cyclosporine