The granuloma annulare is a skin condition. This condition most commonly is characterized by reddish and raised or skin-colored bumps (lesions) that form ring patterns. They are usually appearing on the hands and feet. It is not known the cause for granuloma annulare. Some medications and minor skin injuries can trigger this condition. There are some other types of granuloma annulare which typically affect children and other types affect adults. It is known that in most cases, the granuloma annulare is not itchy or painful so treatment will not be needed. The lesions usually disappear on their own in a period of 2 years. If you are worried about the look of your skin, then your doctor can prescribe you medications which will speed the disappearance of lesions. There are many cases when people who suffer from granuloma annulare mistake it with ringworm because these two conditions look similar but they are not the same. You should visit your dermatologist to get a proper diagnosis. If you have granuloma annulare, then you may not have to treat it because this condition tends to go away on its own without treatment. In most cases, people have one or a few patches on their skin but also it is possible for patches to cover a large amount of the body. [1,2]
Symptoms of Granuloma Annulare
The signs and symptoms of this skin condition are varying and they depend on the variety:
Under the skin This is a type of granuloma annulare which is affecting young children and it is called subcutaneous granuloma annulare. This type of granuloma annulare is producing firm and usually painless lumps under the skin instead of a rash. These lumps are usually less than 3.5 cm (1.4 inches) in diameter and they appear on the scalp, shins and hands.
Generalized It is known fact that up to 15% of people who suffer from granuloma annulare have lesions over a large portion of their bodies, including legs, arms and trunk. This is an itchy type of granuloma annulare and it affects adults.
Localized It is the most common type of granuloma annulare. The lesion (bump) borders have a semicircular or circular shape and it has a diameter up to 5 cm (2 inches). This type of granuloma annulare is happening most commonly on the ankles, wrists, feet, and hands of young adults and children. This type of granuloma annulare usually gets better on its own in a period of a few months. Patches are pink, purple or skin-colored. When the ring gets bigger, then they become flatter and purpler in color before eventually fade. When someone has this type of granuloma annulare, then the top of the skin feels smooth, unlike in other conditions, such as eczema, ringworm or pityriasis Versicolor, it is not rough, scaly or dry. Also, the affected skin is feeling firm as a result of inflammation in the dermis (which is the middle layer of the skin). There is not a change in the epidermis (which is the outermost layer of skin).
You need to speak with your doctor if your skin develops reddish lesions (bumps) in the ring pattern which does not go away in a period of a few weeks. Your doctor can diagnose the granuloma annulare from the appearance of your rash. The rarer types of granuloma annulare may be needed to be diagnosed with a skin biopsy. The small sample of the affected skin is taken so it can be studied under a microscope in a laboratory.
Causes of Granuloma Annulare
The cause of this condition is not known. The tissue which is underneath the top layer of the skin (called dermis) becomes inflamed and hypersensitive. It is not known what is causing the skin to react in this way. There are some cases when granuloma annulare can be triggered by:
- Sun exposure [3,4]
- Vaccinations
- Tuberculin skin tests
- Infections, including hepatitis [5]
- Animal or insect bites
- Other minor injuries to the skin
You should know that the granuloma annulare is not contagious. This condition is not caused by allergies and it does not run in families. There are some cases when the granuloma annulare is associated with diabetes but this is a rare case [6].
Risk factors
In some cases, the granuloma annulare is associated with thyroid disease or diabetes and this most often is happening when lesions are widespread or numerous.
References:
[1] Cheng YW, Tsai WC, Chuang FC, et al. A retrospective analysis of 44 patients with granuloma annulare during an 11-year period from a tertiary medical center in south Taiwan. Dermatologica Sinica. 2016;34(3):121-5.
[2] Jordan A. Granuloma annulare vs tinea corporis. Pulse. 2011;71(11):26.
[3] Patrascu V, Giurca C, Ciurea R, Georgescu C. Disseminated granuloma annulare: Study on eight cases. Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie. 2013;54(2):327-31.
[4] Cohen PR, Grossman ME, Silvers DN, DeLeo VA. Generalized granuloma annulare located on sun-exposed areas in a Human Immunodeficiency Virus — Seropositive man with Ultraviolet B photosensitivity. 1990.
[5] Singh SK, Manchanda K, Bhayana AA, Verma A. Allopurinol induced granuloma annulare in a patient of lepromatous leprosy. Journal of Pharmacology and Pharmacotherapeutics. 2013;4(2):152–4.
[6] Meier-Ewert H, Allenby CF. Granuloma annulare and diabetes mellitus. Archives of Dermatological Research. 1971;241(2):194-8.
