This is an extensive example of disemminated granuloma annulare. It is realatively uncommon and therapeutically difficult to manage. PUVA therapy can be quite effective for this problem. A granuloma annulare lesion gradually spreads peripherally in a circular pattern with no apparent scaling. Ringworm or tinea corporis may often be the first diagnosis that comes to mind with these lesions. For more information about granuloma annulare, click here.