granuloma annulare

This teenaged female presented with a persistent annular lesion near her ankle that had been present for over a month. It was asymptomatic and had grown slowly. She is otherwise healthy and takes no medications. She denies any exposure history but does spend time outdoors in the summer when this lesion appeared. They have tried an over-the-counter antifungal cream for over a week without any improvement. She denies any rashes elsewhere.

What is your diagnosis?

Answer: This is a case of granuloma annulare, a benign self-limited condition more commonly seen in younger patients and more commonly in females. It is typically not responsive to treatment but will spontaneously resolve without a trace within a few months. Ringworm is usually more scaly and will be itchy. Lyme disease is not endemic in Kansas and usually presents as an expanding flat red patch after a tick bite (which is often not noted when it is a seed tick). Warts have more surfaces changes with increased texture, unlike what is seen here.

Adult and Pediatric Dermatology
4601 W. 109th St., Suite 116  •  Overland Park, Kansas 66211  •  913-469-1115