Clinical presentation typically clinches it
Diagnosis of granuloma annulare is often made by its characteristic clinical presentation. If the diagnosis is unclear, a skin biopsy may be needed. Histologic exam will reveal histiocytes in surrounding dermal tissue with increased mucin deposition.
Cosmetic concerns?
Localized lesions that are asymptomatic are often left to resolve spontaneously. If there are cosmetic concerns, or if there is significant pruritus, treatment options include intralesional steroid injection into the raised border with triamcinolone, occlusion therapy with clobetasol propionate, or liquid nitrogen therapy.
One small study of 31 patients with localized granuloma annulare showed resolution after 1 treatment with liquid nitrogen in 81% of patients.6 Topical steroids alone do not produce significant results.5 Other agents, including UV light and systemic medications, are available for the generalized form, however, none are curative and relapses are common.
No treatment for lesion; Metformin for diabetes
Our patient chose to have no treatment for his granuloma annulare, but we did put him on metformin for his diabetes. At a 3-month follow-up visit, our patient’s lesion was unchanged in appearance.
Although the disease course is variable, 50% of patients with localized granuloma annulare will see spontaneous resolution within 2 years without scarring.7