Granuloma annulare
Granuloma annulare is an inflammatory skin condition that forms rings of small firm bumps, without scaling and without itching.
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Medicines commonly prescribed for Granuloma annulare
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: OINTMENT, 1mg/gActive substance: mometasoneManufacturer: Glenmark Arzneimittel GmbhPrescription requiredDosage form: CREAM, 0.5 mgActive substance: betamethasoneManufacturer: Galenicum Derma S.L.U.Prescription requiredDosage form: TOPICAL SOLUTION, 1 mg/gActive substance: mometasoneManufacturer: Korhispana S.L.Prescription required
Granuloma annulare is an inflammatory skin condition that forms rings of small firm bumps, without scaling and without itching. It is not an infection, it is not a fungus and it is not contagious. Most of the time it clears on its own, though it may take months or years. Its main practical problem is that it is constantly mistaken for ringworm and treated with antifungals for months to no effect at all.
How it looks
- small firm papules, skin-coloured, pink or violet;
- arranged in a ring, with the centre flatter and of normal colour;
- the ring slowly expands outwards, from 1 to 5 cm;
- the surface is smooth, with no scaling — this is the key difference from ringworm;
- it does not itch or hurt, or itches very little;
- typical sites: backs of the hands and feet, fingers, wrists, ankles, elbows;
- there may be a single lesion or several;
- it is more common in children and young women.
Forms
- localised: the commonest, one or a few rings on the hands or feet; clears on its own within months to a few years;
- generalised: many lesions across the trunk and limbs, more common in adults; it lasts longer, and in this form diabetes and lipid abnormalities are worth excluding;
- subcutaneous: deep painless nodules, mainly in children, on the legs and scalp; sometimes mistaken for cysts;
- perforating: small papules with a central plug;
- patch type: large, slightly depressed areas, often on the legs.
Causes
These are not precisely known. It is an immune-type inflammatory reaction around collagen. Factors described as possibly relevant include:
- minor trauma, insect bites and friction;
- preceding viral infections;
- diabetes, particularly in generalised forms;
- thyroid dysfunction;
- lipid abnormalities;
- some medicines;
- sun exposure in forms appearing on exposed areas;
- exceptionally, and only in atypical forms of sudden onset in adults, lymphoproliferative disorders.
Granuloma annulare or ringworm
This deserves its own section, because it is the commonest mistake:
- granuloma annulare: the border is made of firm papules, the surface is smooth with no scale, it does not itch and it does not respond to antifungals;
- ringworm: the border has obvious scaling and sometimes small blisters, it itches, it spreads faster, it improves with antifungals and skin scrapings are positive for fungus.
Where there is doubt, a skin scraping settles the question in minutes and saves months of pointless treatment.
When to see a doctor
- ring-shaped lesions have appeared and you do not know what they are;
- they have been unchanged for months or are still spreading;
- there are many lesions across the body;
- they have appeared suddenly in an adult;
- there is intense itching, scaling or pain — it is probably something else;
- they come with intense thirst, passing urine often or weight loss;
- they bother you cosmetically;
- you have already used antifungals with no result whatsoever.
How it is diagnosed
Usually by examination: the appearance is recognisable. A scraping is taken to exclude fungus and, where there is doubt, a skin biopsy, which is conclusive. In generalised forms, glucose, HbA1c, lipid profile and thyroid function are checked.
Treatment
It is worth saying plainly: in the localised form, not treating is a perfectly reasonable option, because it disappears on its own without scarring. Treatment is considered when the lesions are cosmetically troublesome or extensive.
- potent topical corticosteroids, sometimes under occlusion;
- steroid injection into the edge of the lesion;
- topical calcineurin inhibitors;
- cryotherapy for isolated lesions;
- phototherapy for generalised forms;
- systemic drugs — hydroxychloroquine, dapsone, isotretinoin, methotrexate — for extensive resistant disease;
- diabetes control if present;
- sun protection in photodistributed forms.
Curiously, a biopsy can make the lesion disappear: the trauma of the procedure sometimes resolves the ring.
Common questions
Is it contagious? No, not at all.
How long does it last? Half of localised cases resolve within two years. The generalised form lasts longer.
Does it scar? No. A mark may remain and fades with time.
Does it mean I have diabetes? In the localised form, almost never. In the generalised form it is worth checking.
Can it come back? Yes, even in the same place — and it can resolve on its own again.
Online consultation
In an online consultation the doctor reviews photographs, helps distinguish granuloma annulare from ringworm — sparing months of useless antifungals — advises whether a biopsy or blood tests are needed, and explains when treatment is worthwhile and when simply waiting is.
This material is for information only and does not replace a medical consultation.
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Reviewed on Jul 5, 2026
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