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Am Fam Physician. 2022;106(1):85-86

Author disclosure: No relevant financial relationships.

A 26-year-old woman presented with mildly tender, circular, hyperpigmented skin lesions with small bumps affecting the dorsum of both hands (Figure 1) and the medial aspect of the left foot. The lesions, which were first noticed approximately five months earlier, had an insidious onset and grew slowly. There was no pruritus or drainage.

The patient had mild arthralgias in her hands and feet. She had no recent travel or exposure to wilderness areas. She had a history of tobacco use. Laboratory workup was negative for inflammation.


Based on the patient’s history and physical examination findings, which one of the following is the most likely diagnosis?

  • A. Annular lichen planus.

  • B. Arthropod bite.

  • C. Cutaneous sarcoid.

  • D. Granuloma annulare.

  • E. Tinea corporis.


The answer is D: granuloma annulare, a benign, noninfectious, asymptomatic, granulomatous skin condition. Although the pathogenesis is unclear, it is theorized to be related to a hyper-sensitivity reaction. Iatrogenic processes such as drug reactions and bacterial and viral exposures may be associated triggers.1 Granuloma annulare is more common in women and individuals younger than 30 years. A form of granuloma annulare presenting as subcutaneous nodules is more common in children.2

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This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

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