Granuloma Annulare

Granuloma annulare is a skin disease characterized by red colored small bumps that appear close to each other in the shape of circle. The disease was first recognized by T.Colcott Fox in the year 1895. The red bumps seen in certain cases should not be mistaken for Syringoma which develops due to overgrowth of cells from sweat glands. Syringoma – types, causes and treatment are different from that of Granuloma annulare.

Here is an overview of the skin disease Granuloma annulare in which the benign tumors develop due to the cell mediated Type IV immunity that involves the tissue monocytes.

Granuloma Annulare

High Risk Group

• Young adults above 30 years of age and children below ten years of age are increasingly prone to this skin disease.
• People suffering with other diseases such as thyroid disorder and diabetes.
• Females are at increased risk of the disease than males.

Variants of Granuloma Annulare

Depending on the extent to which the red rashes develop there are different variants of Granuloma annulare.

They are

• Localized Granuloma Annulare

  Most common form in which the rashes are restricted to particular area such as the feet, lower limbs, ankles and wrists.

• Subcutaneous Granuloma Annulare

  Mostly observed in children. Hard nodules develop deep in the skin layers in the regions of buttocks, dorsal feet, hands, eyelids and scalp.

• Generalized Granuloma Annulare

  Common form that is observed more in adults. The lesions are wide spread and are observed more in neck, face, scalp, soles and extremities.

• Perforating Granuloma Annulare

  A very rare form that is mostly seen in extremities and the trunk region. The papules generally result in scarring of the skin.

Granuloma Annulare Causes

There is no specific cause for this skin disease. Even healthy people can suffer with this disease. However, people with autoimmune diseases such as systemic lupeus erythematous (SLE) can show the symptoms of granuloma annulare. Areas that are exposed to sun are also at increased risk of developing the rashes. Extreme stress is also being considered as a trigger for the skin disease.

Granuloma Annulare Symptoms

• Presence of small red bumps in a ring shape is the only characteristic symptom of this disease. However, some patients report slight itchiness. The rashes develop due to aggregation of T-cells beneath the skin.
• The reddish papules usually appear at the back of the hands, feet and forearms. Rarely the bumps may be seen throughout the body.
• In few cases, firm nodules develop under the skin of the legs and arms.

Granuloma Annulare Diagnosis

• Granuloma annulare is often confused with fungal infections. Hence, for appropriate treatment KOH test and skin scrapping is done.
• MRI scan, CT scan and radiographs are used for the diagnosis of lesions present in the deep layers of skin.
• In case of severe pain and rapid enlargement of the subcutaneous lesions skin biopsy may also be done to confirm the disease.

Granuloma Annulare Treatment

• The disease does not cause inconvenience and hence, it does not require any treatment. However, the skin loses its natural appearance. Thus, steroid creams are used to clear the bumps. In more severe cases, steroid injections may also be used at the region where the ring is localized.
• Oral corticosteroids such as methylprednisolone and clobetasol propionate can be used to treat the rashes. The corticosteroids act by either suppressing or modifying the immune response.
• The spread of the rashes is reduced by injecting corticosteroids such as triamcinoone subdermally.
• If the patient develops dense nodules then they are frozen using liquid nitrogen.

Lastly, granuloma annulare is a skin disease that does not cause any side effects and disappears naturally within a period of two years. But, it may also last for years in few people especially in old aged people.