DEAR DR. ROACH: I am 58 and have been diagnosed with granuloma annulare, which I’ve had for more than a year and a half. I have both rings (that start small, like a cigarette burn, and then get larger) and spots, which look like birthmarks. I tried changing my diet, but it didn’t have any effect. I can’t wear shorts, because they are unsightly. I am told that there is no remedy for this. I have been using a topical cream, clobetasol, which doesn’t seem to help. My research tells me that it usually goes away after two years, but I also have seen several cases where it never goes away. Please give me some good news! — D.R.

ANSWER: The good news is that they usually do go away (50 percent within two years). They don’t turn into skin cancer and, generally, don’t cause a lot of problems other than being unsightly. Some studies have associated granuloma annulare (GA) with medical conditions such as diabetes and cancer, but it’s not clear if this is actually true.

The skin cream you are using works for many people, but an injection of a steroid is more effective — it’s successful in about 80 percent of people. These can be repeated in six to eight weeks if needed.

The spots also can be frozen with liquid nitrogen, but this can leave scarring. Ultraviolet light has been shown to be helpful.

DEAR DR. ROACH: I am an 84-year-old woman in good health. I had been diagnosed with possible lupus since 1996, because of the high sedimentation rate in my blood. Since I had none of the symptoms of this autoimmune disease, my blood samples were sent to a lab. It came up with the diagnosis of Sjogren’s syndrome. I have only minimal dry eyes and dry mouth. Is there any chance that the abnormal lab results could be an aberration? — E.R.

ANSWER: Blood tests are very useful in helping to make diagnoses, but in the case of both lupus (I mean systemic lupus erythematosus) and Sjogren’s syndrome, diagnosis can’t be made by lab tests alone. The sedimentation rate, or ESR, usually is high in these rheumatologic diseases, but it can be high for many reasons, such as infection, autoimmune disease or malignancy. Older women tend to have higher levels normally. A high ESR alone is not diagnostic of any specific condition.

SLE is a disease of the body’s immune system, where multiple systems are attacked. The diagnosis of lupus is made by a combination of symptoms — such as rash, arthritis, neurologic problems or kidney disease. Blood-test abnormalities alone rarely make the diagnosis. Occasionally, a blood test will turn positive before other symptoms develop.

Similarly, Sjogren’s syndrome is diagnosed if there are both symptoms of abnormal tear and saliva production, and biopsy and lab tests of Sjogren’s antibodies. If you have the Sjogren’s antibodies and have symptoms of eye and mouth dryness, a definitive diagnosis of Sjogren’s would still require an abnormal eye exam, salivary-gland biopsy or abnormal saliva tests.

Most conditions and diseases range in severity from unnoticeable to life-threatening. It’s possible you have a relatively mild form of Sjogren’s that isn’t going to get any worse. It’s also possible that you have a false-positive lab test, and don’t actually have Sjogren’s.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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