Granuloma Annulare - Causes, Symptoms and Treatment

Granuloma annulare (GA) is a common condition. GA is a self-limited cosmetic disease without any systemic medical complications. GA has been epidemiologically linked to diabetes mellitus, necrobiosis lipoidica diabeticorum, and rheumatoid nodules. It appears most often over knuckles and other joints or in places that are subject to frequent, mild injury such as the back of the hands or top of the feet. It is seen most often in older children and young adults. Granuloma annulare (GA) is a benign self-limited dermatosis characterized by a raised annular configuration. Sometimes it appears at the site of a previous penetrating injury. PG is often observed in infancy and childhood but also may be observed in adults, particularly in pregnant women. PG is a benign vascular tumor, mostly occurring in childhood. Lesions may bleed and ulcerate.

PG may affect white populations more than other racial groups, but this is not well proven and the observation may reflect sampling bias. GA is occasionally quite widespread (generalized GA) and this may be an entirely different condition. GA has been associated with diabetes mellitus and thyroid disease based on an increased number of GA patients with these diseases in small case series. Most patients are over age 40, and there is often severe itching. Patients with generalized GA characteristically present with a few to thousands of 1- to 2-mm papules or nodules that range in color from flesh-toned to erythematous and involve multiple body regions and patients with subcutaneous GA present with a firm, nontender, flesh-colored or pinkish nodule without overlying epidermal alteration.

Causes of Granuloma Annulare

1.Granuloma annulare.

2.Pyogenic granuloma.

3.Diabetes mellitus.

4.Herpes zoster lesions

Symptoms of of Granuloma Annulare

1.Reddish or skin-colored bumps (lesions).

2.Mild itching.

3.Nodule under the skin of the arms or legs.

Treatment of Granuloma Annulare

Troublesome patches may improve using steroid creams or ointments, or occasionally steroid injections into the rings. Sometimes it is helpful to apply a strong steroid preparation to the skin or steroids can be injected into the bumps themselves. Small plaques can be frozen (cryotherapy). Topical imiquimod and topical calcineurin inhibitors (tacrolimus and pimecrolimus) have been reported to help individual cases. Surgical tape saturated with a corticosteroid, or injected corticosteroids may help clear up the rash. People with large affected areas often benefit from treatment that combines phototherapy (exposure to ultraviolet light) with the use of psoralens (drugs that make the skin more sensitive to the effects of ultraviolet light). This treatment is called PUVA (psoralens plus ultraviolet A).