Generalized granuloma annulare commonly occurs in older adults. Atypical (perforating) forms are well known, but treatment can sometimes be complicated. A case of atypical generalized granuloma annulare successfully treated with PUVA is reported. The histology and immunohistology of the skin, histopathologic, immunohistopathologic and electronmicroscopic studies of the liver, immunoserology and laboratory investigations are detailed. The most important findings were as follows; diabetic glucose tolerance test, typical histology of the skin disease, steatosis and non‐specific reactive hepatitis, focal Kupffer cell proliferation, Kupffer cell autoantibodies in the liver and slightly enhanced liver functions. The hepatic lesions observed and latent diabetes mellitus are considered to be correlated with the generalized dermal symptoms.