Granuloma Annulare
Description of Skin Lesions: This 49-year-old female had a 9-month history of smooth, slightly erythematous papules arranged in annular plaques on the dorsal aspects of both hands (see Figure 1).



(Enlarge Image)



Figure 1.



Smooth, slightly erythematous papules arranged in annular plaques.





Etiology: The cause of granuloma annulare is unknown. Granuloma annulare can occur at any age, but is seen predominantly in children and young adults. It occurs more frequently in females than males.

Location: Localized granuloma annulare lesions usually start on the dorsal aspect of the hands and arms but may also start on the feet. In the generalized form of the disease, the lesions may be found anywhere on the body including the scalp.

Hallmark of the Disease: Granuloma annulare is characterized by rings of closely set, small, smooth, firm papules which usually are skin colored but may also be slightly erythematous or have a purplish hue. There may be one singular lesion or multiple lesions varying in size from 1 cm to 5 cm. The lesions are usually asymptomatic and nonpruritic.

Treatment: The most common treatments for granuloma annulare are topical and/or intralesional steroids, and there has been some success with PUVA treatments.

Normal Course: Granuloma annulare lesions develop slowly and remain for months or years. Most lesions will disappear spontaneously within 2 years. Recurrence of the lesions is common.

Patient Education: The nurse must ensure that the patient has proper understanding of the clinical diagnosis and the treatment options.

Nursing Measures: This patient was prescribed PUVA soaks, which included soaking the hands in 4 liters of water with 10 mg of UltraMOP (methoxsalen) for 15 minutes two times per week. The hands were then patted dry and exposed to UVA. It is important to give careful explanations of the adverse effects of PUVA treatment, such as sunburn, aging of the skin, and the increased risk of skin cancer. The patient must be instructed to apply sunscreen to the treated areas prior to leaving the clinic and to avoid natural sunlight while having PUVA treatments. The nurse must provide emotional support because the response to therapy is slow and may require many treatments.

The "Clinical Snapshot" series provides a concise examination of a clinical presentationincluding history, treatment, patient education, and nursing measures. Using the format here, youare invited to submit your "Clinical Snapshot" to Dermatology Nursing.