Differential diagnosis

The following annular skin conditions should be considered in the differential diagnosis:

• tinea corporis
• pityriasis rosea
• nummular eczema
• psoriasis

Note: Lack of any vesicles, scales or pustules help in differentiating granuloma annulare from the above named conditions. Less common conditions that need to be ruled out include:

• erythema migrans of Lyme disease
• subacute cutaneous lupus erythematosus
• erythema annulare centrifugum

Note: the latter two conditions have associated scaling. Other rare conditions that are in the differential of granuloma annulare include:

• sarcoidosis, which may present with reddish-brown to purplish infiltrated papules and plaques that commonly are found on the face
• Hansen's disease (leprosy), which also has erythematous annular plaques with associated scaling, alopecia, and anesthesia (1)

Reference:

• 1 Cyr PR. Diagnosis and Management of Granuloma Annulare. Am Fam Physician 2006;74:1729-34