Granuloma annulare vs tinea corporis

The latest in GP and hospital practitioner Dr Andy Jordan's series on differentiating two often similar-looking skin conditions

Both granuloma annulare and tinea corporis conditions may have a circular appearance with a raised edge, but their aetiology and treatment are very different.

Granuloma annulare

• Usually occurs before middle age

• Twice as common in women as in men

• Presents as a papule which gradually expands to form a ring of red or flesh-coloured papules, like cobblestones – you can stretch the skin to see this better

• No scale – due to dermal pathology

• Tends to enlarge centrifugally

• May be solitary or multiple

• Can appear anywhere, but usually on back of hands, feet, ankles or the overlying bony promontories of fingers

• Painless, but may be itchy – especially during the expanding phase

• Possible – but unusual – association with diabetes, so it's worth testing urine

• Tends to remit spontaneously, but if itchy topical steroids may be used sparingly

• Intralesional steroids and cryotherapy are effective for localised lesions.

Tinea corporis

• Can occur at any age

• Is an infection of hair-free skin caused by any of the dermatophytes

• Equal incidence in both sexes

• Very characteristic lesions – usually circular with a raised erythematous active, scaly edge

• Lesions may be single or multiple

• Often central resolution of inflammation, but there may be post-inflammatory pigmentation in the centre of the lesion

• Size of the lesion gradually increases

• Lesions may be anywhere on the body

• Pustules may be present in the lesion if the dermatophyte is of animal origin

• Infection may have arisen in the web spaces of the toes, so check the feet

• Runs a chronic indolent course without treatment

• Topical imidazole or topical terbinafine may be all that is needed, but oral terbinafine might be necessary

• If topical steroids have been used inappropriately on the lesion, then the scale may not be evident (tinea incognito)

• Have a low threshold for taking skin scrapings.

Dr Andy Jordan is a GP and hospital practitioner in dermatology in Chesham, Buckinghamshire

Tinea corporis Tinea corporis Granuloma annulare Granuloma annulare

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