A 16-year-old boy presented with an extremely pruritic rash on the elbows, at the wrists, and on the top of the hands. He was in good health and had never had skin problems before.
Key point: The rash is actually composed of small, firm papules that coalesce into round arrays (annular configuration). This is classic for granuloma annulare. This disorder is more common in children and young adults, although it can be seen in any age group.
Treatment: Application of ultrapotent topical corticosteroids may lead to resolution. Intralesional injections of dilute triamcinolone acetonide (2 to 3 mg/mL) will help eradicate resistant plaques.
Note: Very widespread granuloma annulare may be a sign of diabetes mellitus.