Granuloma annulare is a peculiar skin disorder of unknown cause.1 Asymptomatic, annular, skin-colored to violaceous papules and plaques mysteriously erupt on nonfacial skin, usually without any obvious cause. A loose collection of histiocytes surrounds or infiltrates a more amorphous and rather acellular zone of degenerated connective tissue and mucin. Often the disorder resolves with or without treatment.
Perhaps inflammation is aberrant,2- 4 and the nature of inflammation differs from person to person, based on some genetic perturbation. Perhaps an “ordinary” event such as a tuberculin skin test, trauma, infection, insect bite, or sun exposure starts an inflammation that deviates from its usual path and morphs into a persisting necrobiotic granuloma instead of resolving. Based on this hypothesis, one might predict that patients with granuloma annulare would develop other bizarre inflammatory disorders or odd sequelae, even many years later. Perhaps they might even die from an odd disease or disorder.
To test this prediction, we identified the Mayo Clinic records of patients with granuloma annulare. The institutional review board approved a retrospective medical chart review of these records in a study designed to survey the development of subsequent disease among affected patients. The study was a qualitative pilot study. No attempt was made to age- or sex-match subjects.
The study group consisted of 32 patients with granuloma annulare seen at Mayo Clinic between 1950 and 1970. All subjects had follow-up visits at Mayo Clinic for at least 20 years. The charts were screened for unusual diseases and for diseases related to connective tissue, odd inflammations, or unusual diseases. There were 21 female and 11 male subjects. The average age at diagnosis was 48 years (age range, 4-58 years). Only 3 were children younger than 12 years. The mean follow-up was 35 years (follow-up range, 20-53 years).
The patients seemed remarkably healthy, even in old age. No patient had granuloma annulare at last examination. Interesting comorbidities are listed in the Table. Most patients with conditions or diseases had only ordinary ones such as hypertension, hyperlipidemias, degenerative joint disease, and atherosclerosis.
In summary, patients who develop granuloma annulare usually heal, remain remarkably healthy, and do not ordinarily develop other odd diseases.
Correspondence: Dr Dahl, Department of Dermatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (email@example.com).
Financial Disclosure: None reported.
Funding/Support: This research was supported by the Mayo Clinic Arizona.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and
Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early
dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA Dermatology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 4
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.