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.

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 as a cause. 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 this skin condition that we may not be aware of yet and possible ones to look into in the future include Zocor, Fosamax, levoxyl and topiramate.
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 prescription 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 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 cases are children. Most subcutaneous granuloma annulare lesions are located on the extremities and some can be seen in the scalp..

Granuloma Annulare research studies
Treatment of disseminated granuloma annulare with a 5-lipoxygenase inhibitor and vitamin E.
Br J Dermatol. 2002.
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.

Granuloma Annulare treatment and cause emails
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.
   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? Are there natural supplements, herbs or vitamins that could be of benefit?
   A. There's been no such studies with lipoic or serrapeptase, and I can't think of a mechanism that would make these nutrients be helpful in this condition. As soon as I come across research studies regarding the role of dietary supplements, I will post them on this page.

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?
   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.

Q. I am a 62 year old female who has had disseminated granuloma annulare for over 3 years. My diagnosis was initially confirmed by biopsy and again 2 years later by biopsy. I have been to several dermatologists in the Chicago area and have tried multiple therapies, topical creams / ointments, antibiotics, other oral medications, narrowband UVB and PUVA; yet the disease persists. I read your article on granuloma annulare research, you discuss treatment of disseminated granuloma annulare with 5-lipoxygenase inhibitor and vitamin E, and you also list three drugs: Zocor, Fosamax and levoxyl at the bottom of your page. Are these drugs listed as possible therapies, or as possible causative agents? This is important to me as I take both Fosamax as well as Levoxyl. I have confidence in my doctor so am only asking you to better understand your article and to discuss with my physician. The next possible therapy he is considering is Dapsone.
   A. We do not recall why those drugs are listed there, certainly not as a treatment. Perhaps we had a question about someone who was taking these drugs and they ended up on the page while we were cutting and pasting. Sorry we can't be sure, we have thousands of pages and sometimes we lose track of every word or sentence. We wish you well and we will try to keep up with research on this topic.

I was in my late 30's when I first got granuloma anulare on my left ankle. Cortisone cream cleared it up. It reappeared in the same location about 8-10 years later two more times. Cortisone cream cleared it up both of those times. About 6 months ago, it showed up again, but this time numerous spots appeared on my thighs and torso in addition to the usual location on my ankle. Cortisone cream was slowly clearing up the spots, but additional spots were rapidly appearing. My doctor was doing some routine blood work and included a test for vitamin D, at my request. It turned out that my vitamin D level was only 4.4 when it should have been in the range of 32 - 100! She told me to take 1000 units of vitamin D supplements, along with zinc and calcium and advised me to make sure I was getting plenty of sleep in order to improve my immune system. This cleared up all of my granuloma anulare spots within a couple of months! Please pass on the importance testing blood levels of vitamin D. I am now convinced that my immune system has a direct affect on my granuloma anulare.
   Thanks for sharing this. I would need to hear similar reports from a few people to see if there is any merit in this approach.

I am a 54 year old female with granuloma annulare. I do take thyroid pills daily 1.75 mg. For the last three years I haven't been able to cure this problem. It is all over my body. My depression is getting worst, I can't stand to look at my self any more. What is it I can do to get rid of this problem? What supplements can I take? I have seen close to 8 doctor's in three years, no one has cure it yet. I would deeply appreciate some advice on what to do.

I have been suffering with generalized granuloma annulare for 9 years. I have seen numerous doctors and have gotten no other treatment indications other than steroids and ultraviolet with little or no apparent effect. I was told to take 400 IU of vitamin E daily along with a daily dose of Zileuton and dietary modifications. My condition is still spreading even with the Zileuton and is quite unsightly. I am an otherwise healthy 60 year old women who exercises regularly and is in good physical condition. I would be so grateful for any treatment approach, including the one I mentioned above. Please help.
    I have been searching the medical literature for natural ways to treat this condition but still have not found good studies that indicate an effective approach.

I have had CFIDS for 10 years and 2 years ago I developed granuloma annulare on my arms. My dermatologist was clueless but gave me cortisol creams. I never used is as my naturopathic doctor (ND) tested me and discovered I had protozoa contamination. He told me to get rid of my cat. I told him I’d rather shoot him. So he modified his recommendation to not kiss my cat. I could follow that. He is treating me with Lypo-Spheric Vitamin C (4,000-6,000 IU), Premier Research Labs Quantum Noni 4 tablets a day, and one other product that I can not remember, maybe d-mannose at 2 teaspoons a day. Anyway after 7 months the parasite level in my urine dropped from 85% down to 15% this last month. He used parasite test drops in a measured urine test tube. I assume that within another 2 months, the lesions will disappear completely and the urine will be totally clear. I am in a support group and after sharing my information, I discovered that 4 of us have granuloma annulare. They are now being treated by my ND, as the dermatologists they have seen don’t have a clue.
    It's difficult to say whether the natural supplements and vitamins made a difference in your particular case or whether it was a matter of time.

I'm 60 years young and have started developing the condition within the last year. I visited my dermatologist and that is what the biopsy revealed. I've had a complete physical and blood work. All is well and I'm in excellent shape, running daily and eating a, mostly, vegetarian diet. I do take lots of supplements. This is what I take: Raw Foods Multi for men over 50, Ubiquinol CoQ10,Gamma Vitamin E, Vitamin D3, Glucosamine, Chondrotin, MSM, Policosanol, Kyolic Garlic, Lutein, Milk Thistle, Choleralla, Prostate Formula, Digest Gold Primal Defense, Carlson Fish Oil, Nattokinase, Host Defense (16 mushrooms), Immune Modulator Infopeptide Spray (balances cytokine production to enhance immune function). My question is can supplements, possibly, be a cause of Granuloma Annulare? I'm thinking, maybe, the immune boosting supplements like Host Defense and Immune Modulator can be causing my immune system to overreact causing this reaction. Is that, even remotely, a possibility, in your opinion?
    Since there is still a lot to be learned about this condition and what causes it, it is theoretically possible that natural vitamins, herbs, and dietary supplements could be a cause in some individuals.

I had this condition for 7 years. It may have resulted from chemotherapy for breast cancer. It was diagnosed by two doctors and a biopsy. A friend suggested I try MSM. After taking oral doses of 1200 units per day for about 2 weeks, the condition cleared by about 80%. Within 2 months it had completely cleared. After several years I stopped taking daily doses of MSM and the condition began to return after a few months, so I began using MSM again, and the condition cleared up again. I continue to use the MSM.

Just wanted to add my experience with treating GA. It showed up on one hand about 2 years ago, and has spread to the second hand. Long story short, I don't like taking drugs. I've read about Vitamin E, Emu oil, and/or Tea Tree oil (applied topically) working for some folks, and one person decided to combine all 3 to apply topically. That's what I've been doing for 2 months, and I see a definite improvement! No new spots either! I DO notice that I have to apply it regularly, at least 2 times a day, for the reduction to continue, and 3-4 times a day is even better. The Emu oil alone seems to work, too. I am also taking 5000 mg Vitamin D, plus other vitamins, and glucosamine. I plan to add MSM to the mix, just to see if that helps. Thanks for continuing to post information on this baffling condition! I hope that we will eventually figure out what the heck this is, and how to treat it!

On your web pages, there were several statements by older women who have developed granuloma annulare. I am 58 and had generalized GA for six years, which was resistant to most treatments, though some slowing was noted with the steroid salve. That said, I had it all over my body except face and back. Nine months ago, I was diagnosed with hypothyroidism and prescribed synthetic thyroxin. Within two months, the GA had faded about 50%; within six months, 90% of the GA has faded and remains gone. I have slight remnants, mostly outlines from the largest sites. Since thyroiditis has been mentioned for years as a possible cause of GA, my dermatologist is now going to order thyroid tests for his GA patients. I'm sending this to you since you are receiving correspondence from other post-menopausal who have been suffering from this medical condition for years.

I have recently been diagnosed with granuloma annulare and it spread all over). Sometimes linked to diabetes and thyroid, I checked and don’t have either. The unsightly patches of raised, bumpy, ring-shaped lesions (rash) are causing me emotional distress so I am desperately seeking ways to make the rash disappear and find what causes this disorder (food, toxins, etc.) to eliminate what may be going on internally. Since a reaction in the immune system may play a role, I am seeking insight as to what may have triggered this and how to eliminate it completely. I am on a mission to find out what may have caused this, what I can do to make it go away and never come back. I have read your website and feel you are one of the only Doctors with a real concern for the patients who experience this disease and take the time to answer their questions and aid in their quest to find a cure. I would like to know if any of your patients tried a gluten free and/or low glycemic diet? I am considering trying both. After eating large quantities of fruit especially mango, I may have spiked my sugar levels. I am also allergic to latex and have a history of chronic idiopathic urticaria totally under control with Fexfenodine. I also do a lot of yard work and may have gotten bitten by a spider or the pesticides in the yard may have taken its toll on my system.
   It is worth trying different treatment plans, including gluten free diets. There are many causes for this condition and it is difficult to diagnose and treat. Hopefully many cases resolve with time.

You provided significant information on your website. I understand you are not taking new patients nor do not give referrals. However, if you become available or come across another Dr. who has some experience with this condition, would you put me on a list to notify? As you know, it is difficult to find any knowledge based Dr’s for assisting in treatment.

Ive had granuloma annulare for 38 years. I've had 4 pregnancies where each time it has disappeared each time. Also whenever I'm on birth control, it goes away. After studying this and talking to a lot of people who have GA, they have found it disappears with pregnancy too.

I am 65 years of age and am suffering from Granuloma Annulare, I have had it for the past 2 years after taking simvastatin. I developed a certain rash (on the patient check form in the prescription package) took 4-5 tablets and developed the exact rash they said may happen, following that I developed GA. I also have thyroidism, which was diagnosed a couple of years ago as well. My GA has not responded to Ultra Violet Light Treatment and also coritsone creams, which were recommended by my dermotologist. I have always followed a healthy lifestyle regarding food intake.