What Is Granuloma Annulare?
Granuloma annulare is a benign skin disorder with small, raised rashes or bumps arranged in a ring pattern. The leading cause of this condition is still unknown. While most cases occur in healthy people, some triggers and associated diseases may cause granuloma annulare. Granuloma annulare is a common condition in children, teenagers, or young adults. The generalized form of granuloma annulare is more likely to occur in older adults and females, with a female to male ratio of 2:1. It is usually not contagious and not painful, but it can make a person feel self-conscious. If it becomes a long-term or chronic condition, it can cause emotional distress.
What Are the Types and Clinical Features of Granuloma Annulare?
It is possible to develop more than one type of granuloma annulare simultaneously. However, the five main types of granuloma annulare are:
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Localized Granuloma Annulare: This is the most common form of the condition granuloma annulare. It constitutes 75 % of all cases and affects younger adults. It causes a circular rash on the skin, which usually begins as small circles and may merge. It involves the forearms, hands, and feet.
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Generalized Granuloma Annulare: Generalised granuloma annulare accounts for 15 % of the cases and usually affects adults. It presents with erythematous bumps over a larger area, anywhere on the body, including the palms of hands and soles of feet. The bumps may or may not be in the ring pattern and vary in color and size (millimeters to centimeters). The bumps eventually join to form large, discolored areas. The rash may cause discomfort or itchiness.
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Subcutaneous Granuloma Annulare: This is a less common type of granuloma annulare that mainly affects young children. It causes the formation of red, pink, or skin-colored lumps under the skin. They stay generally small but can grow.
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Perforating Granuloma Annulare: This form presents small, painful, scaly bumps with crusted centers on the hands and fingers. In some cases, bumps are itchy, painful, filled with pus, or ulcerate. Some people develop widespread bumps that connect and then form more extensive rashes. Perforated granuloma annulare may develop on any body part, usually affecting the hands and fingers. In most cases, the small bumps may join together to form raised patches of skin. This form of granuloma annulare usually leaves scars when it heals.
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Patch Granuloma Annulare: This form is characterized by red, reddish-brown, or purple patch-like lesions on the skin. People may develop one or multiple skin lesions like this.
What Are the Main Causes of Granuloma Annulare?
It is still not clear what causes granuloma annulare, but various triggers and associated diseases may play a role in driving this condition, including:
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Animal or insect bites.
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Tuberculin skin tests.
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Vaccinations.
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Sun exposure.
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Minor skin injuries.
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Drugs.
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Tattoos.
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Certain medications include Allopurinol, Quinidine, Calcitonin, Diclofenac, Amlodipine, and calcium channel blockers.
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Chronic stress.
What Are the Risk Factors Associated With Granuloma Annulare?
Granuloma annulare is less commonly associated with diabetes or thyroid disease, especially when lesions are numerous or widespread. However, it may be related to cancer in rare cases, especially in older people whose granuloma annulare is severe, does not respond to treatment, or recurs after cancer treatment.
How Is Granuloma Annulare Diagnosed?
After a thorough medical history and physical examination, the dermatologist may confirm the diagnosis with a skin biopsy. Granuloma annulare is generally diagnosed clinically because of its characteristic appearance. But in some cases, the diagnosis may not be obvious. Skin biopsy shows necrobiotic degeneration of dermal collagen surrounded by an inflammatory reaction.
What Is the Treatment of Granuloma Annulare?
Granuloma annulare can go away on its own over time. Treatment may help clear the skin faster than left untreated, but recurrence is common. The lesions that return after treatment tend to appear at the same spots, and 80 % of those are usually clear within two years. The untreated lesions may last for a relatively long period.
Treatment options include:
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Corticosteroid Creams or Ointments: The corticosteroid-based products may help improve the appearance of the skin lesions and help them disappear faster. The doctor may advise covering the cream with bandages or an adhesive patch to increase the effectiveness of this treatment.
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Corticosteroid Injections: If topical treatment fails to work, the doctor may prescribe a corticosteroid injection. Injections may be repeated every 6 to 8 weeks until the lesions clear up.
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Freezing or Cryosurgery: This treatment involves applying liquid nitrogen to the affected area to remove the lesions.
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Light Therapy: Exposing the skin lesions to various light treatments, including lasers and ultraviolet (UV) light, may be helpful. In addition, some cases may be treated with a kind of light therapy called PUVA. This light therapy is effective, and it involves taking a Psoralen medication and then treating the skin with UV light.
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Oral medications: For widespreadlesions, the doctor may prescribe oral drugs such as antibiotics, antimalarials, or other medicines used to prevent immune system reactions.
These treatments are known to have some side effects. Thus, it is essential to consult a doctor before starting any therapy.
What Is the Outlook for Granuloma Annulare?
Granuloma annulare goes away within a few years for most people. However, it tends to last longer if it has spread to more body parts than found in just one location. The generalized form may follow a pattern of spontaneously healing only to develop months or years later. About
25 % of cases of generalized granuloma annulare last for more than five years or may last longer than ten years. The skin usually clears naturally without treatment. When granuloma annulare clears, it tends to remove without scarring. However, a rare type called perforating granuloma annulare leaves scars when it clears up. There is no way to prevent granuloma annulare.
Conclusion:
Granuloma annulare is a benign skin condition that causes a raised rash or bumps in a ring pattern. It affects young children. It is not contagious but can make a person feel self-conscious. If it becomes a chronic condition, it can cause emotional distress. Treatment helps clear the skin gradually, but lesions tend to come back. The untreated condition may last from a few weeks to years. Consult a doctor if a rash or bump (lesion) develops in a ring pattern that does not disappear within a few weeks.
