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Therapeutic Approach

Granuloma annulare is a benign granulomatous skin disorder of unknown cause.

Spontaneous resolution within 2 years is usual for the classic localized form although there may be recurrence. Generalized granuloma annulare often has a more prolonged course. Subcutaneous nodules are seen mainly in children and regress with time. Less common variants include the perforating and patch forms.

Patient and/or parent education with advice to await spontaneous remission is recommended in the majority of cases, particularly for localized disease in children. Active treatment may be required for lesions which are symptomatic, extensive, persistent, or particularly unsightly.

There is no ideal evidence-based treatment for granuloma annulare. Reflecting this unmet need, many potential therapeutic approaches have been published in the literature.1,2 Reports of benefit are largely based on case reports and small case series without controls. Treatment often proves disappointing and benefit can be difficult to assess in a condition that remits spontaneously. Potential adverse effects, risk/benefit evaluation, and cost must be considered before initiating a trial of therapy. See Table 15-1.

Table 15-1Granuloma Annulare Treatment Table

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