Annular, Granuloma Annulare, Granulomatous, Teledermatology, Tinea



  1. So, Jessica Kim
  2. Jacob, Sharon E.


ABSTRACT: Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. In this modality, there is transfer of patient medical information electronically (including history and visual data) obtained in one location to a provider who is in another location. The construct of this column is such that cases are presented in a standardized teledermatology reader format. This is a case of an annular pink plaque on the hand.


Article Content


Chief complaint: presenting for diagnosis and therapeutic options.


History of Present Illness

A 29-year-old man presented with a new annular pink plaque on the hand, which was first noted 2 months prior and has since grown larger. Prior treatment: topical terbinafine and ketoconazole creams, which did not alleviate the problem. His primary symptom: mild itching. Prior biopsy: none.



Fully satisfactory.



One image was provided for Problem A (Figure 1). The image clearly shows an annular pink plaque with firm, shiny, pink granulomatous border and flat red-brown center. No scale is appreciated.

Figure 1 - Click to enlarge in new windowFIGURE 1. An annular pink plaque with firm, shiny, pink granulomatous border and flat red-brown center. No scale is seen.



The morphology and distribution of the lesion are most consistent with the diagnosis of granuloma annulare (GA).



Skin Care and Treatment Recommendations

As GA may be self-limited, primary provider may offer reassurance and counsel the patient that observation may be most appropriate for asymptomatic, localized involvement. If treatment is desired, first-line therapy with high-potency topical corticosteroids may be initiated. Sun and ultraviolet light protection is also recommended.



Type of Visit

Return to the primary provider to discuss treatment. If the condition fails to resolve, consult dermatology for face-to-face evaluation, consideration for a punch biopsy to confirm the diagnosis, and/or consideration for intralesional corticosteroid injections.



GA is seen most commonly as firm, smooth annular or arciform plaques with a raised border in children and young adults. Localized GA is the most common form, presenting with lesions up to 5 cm in diameter on acral sites (Ghadially, 2015). The etiology of GA is unknown. Spontaneous resolution occurs in 50% of patients within 2 years, but recurrence occurs in about 40% (Wells & Smith, 1963). If left untreated, lesions may persist from a few weeks to several decades. The clinical differential diagnosis for GA includes other annular eruptions; the annular plaques of dermatophytic infections (tinea) may be distinguished from GA by the characteristically scaly plaques and presence of pustules.




Ghadially R. (2015). Granuloma annulare. Retrieved from[Context Link]


Wells R. S., Smith M. A. (1963). The natural history of granuloma annulare. British Journal of Dermatology, 75, 199-205. [Context Link]


*The standardized teledermatology reader report format is available for authors on the submissions Web site and outlined in Table 1. [Context Link]