Granuloma annulare is a chronic inflammatory skin disease consisting of a rash with reddish bumps arranged in a circle or ring. Granuloma annulare is often of unknown etiology most commonly presenting on the hands and feet and consisting of asymptomatic to mildly itchy, flesh-colored to erythematous annular plaques. Granuloma annulare is a benign, asymptomatic, self-limited papular eruption found in patients of all ages.

Granuloma Annulare incidence
Localized ranuloma annulare most often affects children and young adults. It is slightly more common in girls. The condition is usually seen in otherwise healthy people. Occasionally, it may be associated with diabetes or thyroid disease. Generalized granuloma annulare occurs more commonly in older patients.

Granuloma annulare Cause
There are a number of conditions that are associated with granuloma annulare. The following is a list:

Autoimmune disease
Cancer
Chemotherapy drugs that interfere with the immune system
Diabetes
Drug reaction - One case report indicates amlodipine associated with granuloma annulare. Amlodipine is used alone or in combination with other medications to treat high blood pressure and chest pain (angina). Amlodipine is in a class of medications called calcium channel blockers. Allopurinol is another medicine that can rarely cause granuloma annulare. There may be other drugs that induce granuloma annulare that we may not be aware of yet.
Giardia infection
Hepatitis B and C infection
Herpes Zoster
Immunosuppression
Leukemia and Lymphoma
Thyroid disease including autoimmune thyroiditis
Vaccination with tetanus, BCG,
Granuloma annulare skin lesions have developed in patients during anti-tumor necrosis factor (TNF) therapy.

Natural Treatment for Granuloma Annulare - How to Manage your condition
At this time there is little knowledge on dietary or nutritional options for the treatment of granuloma annulare. The first option is to make sure any of the drugs you may be taking is not causing the condition. Certain drugs can have unusual side effects, either alone or in combination with other drugs. Perhaps if some of the drugs you are taking could be stopped for a couple of months unless they are absolutely necessary.
     Second, make sure you have a full checkup to rule out any conditions listed above that could be causing the skin problem. This would include a routine blood tests plus evaluation for autoimmune conditions. For instance, make sure you do not have diabetes, a thyroid problem, or an infection. Third, consider improving your diet to reduce sugar and sweets, and increase your intake of fresh vegetables and eat more salmon, halibut, tuna, sardines, and fish. See diet for suggestions. Also, improving sleep patterns can help your immune system.
     Lastly, if all else fails,, some of the standard medical options listed below could be tried. Often, granuloma annulare is a self-limited condition that may go away by itself in a few months or a couple of years.

Granuloma Annulare Treatment
The primary granuloma annulare skin lesion usually is grouped papules in an enlarging annular shape, with color ranging from flesh-colored to erythematous. The two most common types of granuloma annulare are localized, which typically is found on the lateral or dorsal surfaces of the hands and feet; and disseminated, which is widespread. Localized disease generally is self-limited and resolves within one to two years, whereas disseminated disease lasts longer. Because localized granuloma annulare is self-limited, no treatment other than reassurance may be necessary, although liquid nitrogen, injected steroids, or topical steroids under occlusion have been recommended for treatment of localized disease. Established therapies for localized forms of granuloma annulare are glucocorticosteroids, cream PUVA and cryosurgery.
   Disseminated granuloma annulare may be treated with one of several systemic therapies such as dapsone, retinoids, niacinamide, antimalarials, psoralen plus ultraviolet A therapy, fumaric acid esters, tacrolimus, and pimecrolimus. Consultation with a dermatologist is recommended because of the possible toxicities of these agents.
 Antimalarials, hydroxychloroquine, antileprotics, ultraviolet phototherapy and photochemotherapy, tumour necrosis factor-alpha inhibitor infliximab, fumaric acid esters, oral isotretinoin therapy, topical tacrolimus (calcineurin inhibitor), may be of value in treating granuloma annulare.

Subcutaneous granuloma annulare
Subcutaneous granuloma annulare is a benign inflammatory disorder that may be alarming in its presentation because of its rapid growth and extensive differential diagnosis. The majority of subcutaneous granuloma annulare cases are children. Most subcutaneous granuloma annulare lesions are located on the extremities and some can be seen in the scalp..

Granuloma Annulare Research
Treatment of disseminated granuloma annulare with a 5-lipoxygenase inhibitor and vitamin E.
Br J Dermatol. 2002 Apr;146(4):667-70.
Histologically, granuloma annulare (GA) is a common non-infectious necrobiotic granulomatous reaction pattern that correlates with a number of different, but relatively specific clinical presentations. The cause or causes of GA are unknown: when localized, it is usually self-limiting, but it may be persistent when disseminated. We present three women who had had disseminated GA for more than 1 year. One patient had previously been treated with isotretinoin with no response. All three patients were treated with vitamin E 400 IU daily and zileuton 2400 mg daily. All responded within 3 months with complete clinical clearing. The anti-inflammatory and immune regulatory effects of vitamin E and zileuton may be an effective treatment in some patients with prolonged disseminated/generalized GA.

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Granuloma Annulare emails
Q.  I have been looking on the internet for help with my granuloma annulare. I have had granuloma annulare since I was about 8 or 10 years old. My parents brought me to the University of Minnesota. They gave me cortisone injections in my legs. They said I would grow out of it. It was only on my ankles and lower legs. What I remember it went away. During my growing up years I don't remember much about it being disturbing, so it must have been minimal. At about age 35 the granuloma annulare became more noticable. It was very reddish purplish. Everyone was asking if I had bruised my legs. It was still only on my ankles and lower legs. I went to Mayo Clinic at that time. They gave me cortisone cream and the usual options. I have tried to think if there was anything I was doing differently. I had started Zoloft approx. 6 months prior. By this time I had a 6 and 4 year old. I was on Zoloft for about 2 yr. I had it until app. age 45 it went away after I started taking vitamin A & E. At age 47 I started taking Zoloft again and later switched to Lexapro. Since then it has been spreading like crazy. I was still taking vit. A&E. During this time I also started to go through menopause. Just in the last couple weeks I have had spots on my abdomen, upper arms, armpits, elbows. I am getting scared it will go to my face. It is very reddened and prominant. People ask me if I have poison ivy. I don't know what I should do. Do I go back to Mayo and get injections? The other options seem more hazardous to your health. PUVA seems out because I am quite fair skinned. Please can you help me? I don't know what to do or where to go as this disease is spreading very rapidly.
   A. We really don't know much more at this time about granuloma annulare than the information on this web page.

Q. Do the supplements lipoic acid or serrapeptase help with granuma annulare?
   A. There's been no such studies, and I can't think of a mechanism that would make these nutrients be helpful in this condition.

Q. i have had granuloma anulare for 23 years. Recently I went to a dermatologist who gave me a series of 3 shots of Kenalog. It completely took it away for a period of time. If it ever does spread all over again, i will go back for the Kenalog shots.

Q. I was diagnosed with granuloma annulare several years ago. I have spots on my hands and mostly on my neck. I have been taken Celexa and Ziac for about 5 years now. Do you think that those medications can be the cause of granuloma annulare?
   A. Celexa is an antidepressant. Ziac is a combination of Bisoprolol and hydrochlorothiazide for hypertension. As of November 2007, we could not find any reports in the medical literature that these two prescription medications cause granuloma annulare. However, as part of the causative agents for this skin condition, many drugs are part of the differential diagnosis.