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Have granumala annulare, tried steroid creams but little improvement. Suggest?

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Practicing since : 2006
Answered : 2016 Questions
Hi I have granumala annulare, ive had it for 5 years and have tried like 2 streriod creams gave them a shot but little approvement. Its embarrasing to have i want to do anything i can to cure it. please message me all the cures you think can help i need my life back im 18 and went through high school with this thing on my hand i need my regular hands back.
Posted Wed, 16 Oct 2013 in Skin Hair and Nails
Answered by Dr. Kalpana Pathak 51 minutes later
Brief Answer:
Please read a detailed answer below

Detailed Answer:
Thanks for writing to us.
I can totally understand your concern.
Granuloma annulare at times can be refractory not responding to one modality of treatment but there are many treatment options available for the same.
The treatment varies according to area of involvement and extent of involvement. Usually for localised lesions we prescribe steroids, tacrolimus, imiquimod, intralesional saline injections, steroid injections, cryotherapy etc.
For generalised lesions isotretinoin, oral steroids, cyclosporine, PUVA therapy can be tried.
i would like you to answer below mentioned queries
number of lesions you are having
if localised or generalised
area involved( face, arms, legs)
size of the lesions- big or small
Also please attach an image of your lesions as it would help me in assessing the lesions and response achieved till now with medication.

This would help me in suggesting most appropriate treatment option in your case.
Hoping to hear from you soon.

Above answer was peer-reviewed by
Follow-up: Have granumala annulare, tried steroid creams but little improvement. Suggest? 13 minutes later
I have 1 on my right hand 1 in wide and 2-3 in lll try to post a pic tomorrow
Answered by Dr. Kalpana Pathak 22 hours later
Brief Answer:
you have localised granuloma annulare

Detailed Answer:
Thanks for writing back.
As the lesions are localised, we can go with topical treatment.
You have mentioned that you have already applied steroid creams and taken steroid shots. The response to steroid depends upon potency of steroid used. So if steroid used was mild like hydrocortisone, response must have been suboptimal.

In your case you may try using clobetasol cream over spots in night under occlusion( cover the area with cellophane or cling film for better absorption) and apply tacrolimus 0.1 percent cream twice in a day. The lesions may take two to three weeks to show response

Along with this either you may take steroid injections intralesionally in the spots or intralesional saline injections. With saline injections a very interesting phenomenon has been noticed in GA.It is said saline injections lead to resolution of GA and this is known as reverse koebnerisation.

If these do not help, try cryotherapy. Cryotherapy helps too but lesion may resolve with scarring or pigmentation.

personally i believe combination of steroid and tacrolimus if used for three weeks to a month should help.

Hope this helped.

Take care

Above answer was peer-reviewed by
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