granuloma annulare ( ga ) was first described in 1895 by colcott - fox who reported an 11-year - old girl with a  ring eruption of the fingers . the condition is a benign , usually self - limited granulomatous disease of the dermis and subcutaneous tissue . clinically , the condition is characterized by asymptomatic , flesh - colored or erythematous - brown papules , frequently arranged in a ring or annular pattern on the distal extremities . it may be skin - colored erythematous or violaceous measuring 1 - 5 cm in diameter . several clinical variants of ga have been reported , namely localized , generalized or disseminated , targetoid , giant , subcutaneous and perforating ga . we report an 18-month - old male child with multiple , progressive ga over the lower extremities . an 18-month - old male child presented with multiple annular lesions over lower extremities and buttocks . initially it started as a small papule over the left thigh , substantially attaining the present size . there was no history of fever , pain , drug intake or recent vaccination . on examination , on cutaneous examination , closely set , skin - colored , firm , smooth papules 2 - 3 mm in size arranged in a ring - like fashion to form annular plaques measuring approximately 3  3 cm ( eight lesions ) were present over dorsal aspect of foot [ figures 1 and 2 ] , both legs and buttocks . granuloma annulare over the left foot granuloma annulare over the right ankle routine hematological , biochemical and urine examinations were normal . venereal disease research laboratory test , human immunodeficiency virus 1 and 2 , hepatitis surface antigen test were negative and a biopsy showed features consistent with ga . ga is a benign , relatively common cutaneous disease that classically presents as closely set , skin - colored , firm , smooth papules 2 - 3 mm in size arranged in a ring - like fashion to form annular lesions . most cases occur before the age of 30 years and it is approximately twice more common in females . it often favors sacral sites such as the dorsa of the hands , elbows and feet but involvement of the palms appears to be rare . occasional familial cases are described with the occurrence in twins , siblings , and members of successive generations . attempts to identify an associated hla sub - type have yielded disparate results in different population groups . linear ga , a follicular pustular form and popular umbilicated lesions in children have also been described . the condition manifests as numerous ( at least 10 , often hundreds to thousands ) small , asymptomatic , erythematous , violaceous , brown- or skin - colored papules . rarely , ga may be complicated by nerve involvement as a result of granulomatous inflammation surrounding cutaneous nerves and perineural infiltrates of histiocytes in the dermis . the differential diagnoses of localized ga include tineacorporis , pityriasis rosea , pityriasis rotunda , erythema annulare centrifugum , nummular eczema , discoid lupus erythematosus , psoriasis , necrobiosis lipoidica , morphea , hypertrophic lichen planus and erythema chronicum migrans . treatment options include topical or intralesional corticosteroids , imiquimod cream , topical calcineurin inhibitors ( tacrolimus , pimecrolimus ) , cryotherapy , and pulsed dye laser .
granuloma annulare is a benign , self - limiting , inflammatory and granulomatous disease of unknown etiology occurring in both adults and children . 
 an 18-month - old male child had multiple progressive annular plaques over the lower extremities . 
 clinical and histopathological features were consistent with granuloma annulare . 
 localized granuloma annulare is the most common form in children . 
 we report a young child with multiple , progressive granuloma annulare over the lower extremities .