Granuloma annulare

  • Overview

    Granuloma annulare : Overview

      granuloma-annulare-overview.jpg
    Granuloma annulare often causes a slightly raised patch on your skin that has a noticeable (and sometimes scaly) border.

    What exactly is granuloma annulare?

    Granuloma (gran-you-low-ma) annulare (ann-you-lar-ē) is a skin condition that usually causes a rash. It isn’t a type of cancer. It isn’t contagious.

    It rarely causes symptoms, such as pain or itch, but it can show up on your skin in different ways.

    What appears on your skin depends on the type of granuloma annulare you have. The most common type causes a slightly raised patch that is ringed by a noticeable border. This patch tends to form on a hand, arm, foot, or leg, but it can appear anywhere on the skin.

    Most people have one or a few patches on their skin. It’s also possible to have patches that cover a large amount of your body. Granuloma annulare can also cause a deep, round lump in the skin.

    If you have a patch of granuloma annulare on your skin, it can be mistaken for another skin condition called ringworm. The two skin conditions look similar.

    You can get an accurate diagnosis by seeing a board-certified dermatologist. If the diagnosis is granuloma annulare, you may not have to treat it. Granuloma annulare tends to go away on its own without treatment.


     

    Image
    Used with permission of Journal of the American Academy of Dermatology: J Am Acad Dermatol. 2014;71(5):1020-22.

    References
    Howard A and White, Jr., CR. “Non-infectious granulomas.” In: Wolff K, et al. Fitzpatrick’s dermatology in general medicine (7th edition). McGraw Hill Medical, USA, 2008:1426-9.

    Piette EW and Rosenbach M. “Granuloma annulare: Clinical and histologic variants, epidemiology, and genetics.” J Am Acad Dermatol 2016; 75:457-65.

    Piette EW and Rosenbach M. “Granuloma annulare: Pathogenesis, disease associations and triggers, and therapeutic options.” J Am Acad Dermatol 2016; 75:467-9.

    Prendiville JS. “Granuloma annulare.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:369-73.


    Granuloma annulare
    Granuloma annulare : Overview
    Granuloma annulare : Symptoms
    Granuloma annulare : Causes
    Granuloma annulare : Treatment
    Granuloma annulare : Tips for managing
  • Symptoms

    Granuloma annulare : Symptoms

    This skin condition rarely causes symptoms, such as pain or itch. Because there are different types, it can show up on the skin in various ways.

    These pictures of granuloma annulare show what you may see on your skin. Some people develop more than one type, so they have a few of these signs.

    Pictures of granuloma annulare


    granuloma-annulare-localized.jpg
     

    Localized granuloma annulare

    Most people develop this type, which causes a raised ring-shaped patch on the skin. Many of these patches are reddish in color (A), but they can also be pink, violet, or skin-colored (B).

    Before you see the rash, you may notice bumps on your skin. These bumps join together to form the rash.

       
    granuloma-annulare-generalized.jpg  

    Generalized granuloma annulare

    Some people develop widespread bumps on their skin that grow together to form large patches, such as shown here. The patches appear in many colors, including skin-colored, reddish pink, violet, or yellow.

         
    granuloma-annulare-subcutaneous.jpg  

    Subcutaneous granuloma annulare

    When this type develops, you often see a roundish, firm, and usually painless lump in the skin. You may have a single mass or clusters of lumps. Most lumps stay the same for months, but a lump can also grow quickly. The lumps tend to be flesh-colored, pink, or red.

         
    granuloma-annulare-perforating.jpg  

    Perforating granuloma annulare

    This rare type usually develops on the hands and fingers. It causes small bumps that often feel scaly. The bumps may leak fluid, itch, or feel painful. Some people have a few bumps. Others develop widespread bumps that join together to form raised patches on the skin. When this type clears, it may leave scars on the skin.

         
    granuloma-annulare-patch.jpg  

    Patch granuloma annulare

    When this rare type develops, you see one or more patches on the skin. The patches may be red, reddish brown, or violet. Some people have one or a few patches; others have widespread patches.


    There are other types of granuloma annulare, but these are very rare.


    Images
    Used with permission of Journal of the American Academy of Dermatology:

    • Image 1, 2, 3, 4, 5: J Am Acad Dermatol. 2016;75:457-65.
    • Image 6: J Am Acad Dermatol. 2000;42(3):417-21.

    References
    Howard A and White, Jr., CR. “Non-infectious granulomas.” In: Wolff K, et al. Fitzpatrick’s dermatology in general medicine (7th edition). McGraw Hill Medical, USA, 2008:1426-9.

    Piette EW and Rosenbach M. “Granuloma annulare: Clinical and histologic variants, epidemiology, and genetics.” J Am Acad Dermatol 2016;75:457-65.


    Granuloma annulare
    Granuloma annulare : Overview
    Granuloma annulare : Symptoms
    Granuloma annulare : Causes
    Granuloma annulare : Treatment
    Granuloma annulare : Tips for managing
  • Causes

    Granuloma annulare : Causes

    woman-reading-book-to-two-young-girls.jpg
    Some types of this skin condition develop almost exclusively in children, while other types tend to appear in older adults.

    Who gets granuloma annulare?

    Medical records indicate that this skin condition is more common in females than males. It also seems that the perforating type of granuloma (gran-you-low-ma) annulare (ann-you-lar-ē) develops most often in people who live in Hawaii. Otherwise, this disease seems to occur about equally in people of different races and parts of the world.

    Most people who get this skin condition are otherwise healthy. Some studies, however, have found that people with certain diseases, such as an HIV infection, may be more likely to develop granuloma annulare.

    Children tend to get the localized and subcutaneous types of granuloma annulare. The generalized and perforating types are more common in older adults.

    Infants rarely get this skin condition.

    You can see what the different types look like at:

    Granuloma annulare: Signs and symptoms

    What causes granuloma annulare?

    It’s still unclear what causes this skin condition. Through studying granuloma annulare, scientists have learned that many things can trigger it. People often develop granuloma annulare after they:

    • Injure their skin
    • Take certain medications
    • Develop another disease

    It may be that granuloma annulare is a reaction that occurs in the skin. It may require a trigger, such as injuring your skin. Granuloma annulare often appears after people injure their skin.

    Because this skin condition doesn’t develop in everyone who injures their skin, it’s possible that the people who develop it are especially sensitive to whatever injured their skin.  For example, people have developed this skin condition after getting bit by an octopus, stung by a bee, or inked by a tattoo artist.

    Granuloma annulare may also be more common if someone has a disease, such as the human immunodeficiency virus (HIV), thyroid disease, or diabetes. Not everyone who has one of these diseases will develop granuloma annulare. Again, it’s possible that the skin is reacting to what’s going on inside the body.

    Before we know for sure what causes granuloma annulare, more research is needed.


    Image
    Getty Images

    References
    Howard A and White, Jr., CR. “Non-infectious granulomas.” In: Wolff K, et al. Fitzpatrick’s dermatology in general medicine (7th edition). McGraw Hill Medical, USA, 2008:1426-9.

    Piette EW and Rosenbach M. “Granuloma annulare: Clinical and histologic variants, epidemiology, and genetics.” J Am Acad Dermatol 2016; 75:457-65.

    Piette EW and Rosenbach M. “Granuloma annulare: Pathogenesis, disease associations and triggers, and therapeutic options.” J Am Acad Dermatol 2016; 75:467-9.

    Prendiville JS. “Granuloma annulare.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:369-73.


    Granuloma annulare
    Granuloma annulare : Overview
    Granuloma annulare : Symptoms
    Granuloma annulare : Causes
    Granuloma annulare : Treatment
    Granuloma annulare : Tips for managing
  • Treatment

    Granuloma annulare : Diagnosis, treatment, and outcome

    dermatologist-examining-young-girls-skin.jpg
    Many people who have granuloma annulare don’t need treatment.

    How do dermatologists diagnose granuloma annulare?

    If you may have granuloma annulare (gran-you-low-ma) annulare (ann-you-lar-ē), your dermatologist will exam your skin and ask some questions.

    Be sure to tell your dermatologist if you:

    • Have injured your skin recently
    • Feel any pain or itch
    • Take any medications
    • Have been diagnosed with a disease

    The skin exam and information you provide are often enough to diagnose granuloma annulare.

    If it looks like you may have another condition, you may need medical testing. To test for another condition, your dermatologist may remove a bit of skin, so that it can be examined under a microscope. This is called a skin biopsy.

    Your dermatologist can quickly remove the skin needed for a skin biopsy during your exam. A skin biopsy helps rule out a condition, such as a skin infection.

    Medical tests, such as a blood test or CT scan, can also help rule out other diseases.

    Testing is important because some research studies show that people with granuloma annulare have a higher risk of developing a few other diseases, such as diabetes, thyroid disease, or HIV (human immunodeficiency virus). Not all research studies have found this to be true. Until we know for sure, it can be helpful for some people to get tested for these diseases.

    How do dermatologists treat granuloma annulare?

    Most people don’t need treatment. This skin condition tends to clear on its own. Since it’s not contagious, you can leave it alone until it clears. Clearing may take a few months or a few years. Most people see their skin clear within 2 years.

    No one treatment has proven effective for everyone. Some people need to try different options before finding treatment that works.

    granuloma-annulare-treatment-options.jpg

    If you have a type of granuloma annulare that covers a large area of your body or causes a deep growth in your skin, your dermatologist may recommend treatment. Treatment may also be an option if you have noticeable patches and dislike how your skin looks.

    If you have a few noticeable patches, these are often treated with:

    • Corticosteroids you apply to your skin: This medication reduces inflammation, which can help your skin clear more quickly.

    • Injections of a corticosteroid: Your dermatologist may inject the patches to reduce the inflammation, which can help your skin clear more quickly.

    • Cryotherapy: This freezes your skin, which can destroy the raised patches.

    If the granuloma annulare covers much of your skin or you have a deep lump in your skin, you’ll have different treatment options. For these types of granuloma annulare, you may need:

    • Medication used to treat malaria: Studies have shown that this can be quite effective. It can take time to see the results. In one study, patients started to see results after taking the medication for about 3 months.

    • Light therapy: Exposing the skin with granuloma annulare to ultraviolet (UV) light in a controlled way can be helpful. Some people receive a type of light therapy called PUVA. This involves taking a medication called psoralen and then treating the skin with UVA light. The medication makes your skin more sensitive to light, so light therapy can be more effective. Another type of light therapy, laser treatments, can also be helpful.

    Some cases of granuloma annulare can be stubborn. The first treatment you try may not work. For this reason, dermatologists use different treatments that can help clear the skin.

    While granuloma annulare is not an infection, an antibiotic may help be helpful for some people.

    Before using a treatment, your dermatologist will weigh the risk of possible side effects against the effects that granuloma annulare has on your quality of life.

    What is the outcome for someone who has granuloma annulare?

    The skin usually clears on its own without treatment.

    How long it takes the skin to clear varies. Some people clear in a few months. Most people see the signs go away within 2 years. Clearing can also take longer.

    When granuloma annulare clears, it tends to clear without leaving a trace. If you develop a rare type called perforating granuloma annulare, you may see scarring when the granuloma annulare clears.

    While granuloma annulare usually clears on its own, it also tends to return. It may return months or years after it clears. This happens whether or not you treat it. When it returns, it tends to appear in the same place and clear more quickly.


    Images
    Getty Images

    References
    Ghadially R. “Granuloma annulare.” Medscape. Updated Sep 7, 2017. Last accessed Feb 28, 2018.

    Grewal SK, Rubin C, et al. “Antimalarial therapy for granuloma annulare: Results of a retrospective analysis.” J Am Acad Dermatol 2017; 76:765-67.

    Howard A and White, Jr., CR. “Non-infectious granulomas.” In: Wolff K, et al. Fitzpatrick’s dermatology in general medicine (7th edition). McGraw Hill Medical, USA, 2008:1426-9.

    Piette EW and Rosenbach M. “Granuloma annulare: Clinical and histologic variants, epidemiology, and genetics.” J Am Acad Dermatol 2016; 75:457-65.

    Piette EW and Rosenbach M. “Granuloma annulare: Pathogenesis, disease associations and triggers, and therapeutic options.” J Am Acad Dermatol 2016; 75:467-9.

    Prendiville JS. “Granuloma annulare.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:369-73.


    Granuloma annulare
    Granuloma annulare : Overview
    Granuloma annulare : Symptoms
    Granuloma annulare : Causes
    Granuloma annulare : Treatment
    Granuloma annulare : Tips for managing
  • Tips for managing

    Granuloma annulare : Tips for managing

    dermatologist-examining-older-womans-hand.jpg
    Getting an accurate diagnosis is important. Some skin conditions that look like granuloma annulare require treatment.

    Granuloma (gran-you-low-ma) annulare (ann-you-lar-ē) is a skin condition that’s usually nothing to worry about. If you think you might have it, the following can help.

    1. See a board-certified dermatologist for a diagnosis. It’s very possible that the rash or deep lump in your skin is granuloma annulare. Because many other skin conditions can look like granuloma annulare, you want to see a board-certified dermatologist. These doctors are the skin experts who can help you get an accurate diagnosis.

      An accurate diagnosis is important to your health. Some skin conditions that look like granuloma annulare, such as ringworm, require treatment.

    2. If you have granuloma annulare, be patient. This skin condition tends to clear on its own without treatment. Patience is important because clearing can take time. Some patients see their clear skin in a few months. Most will see clearing within 2 years.

    3. If you develop symptoms like itch or pain, see your dermatologist. Most people remain symptom free. If itch, pain, or tenderness occur, treatment can help relieve your symptoms.

    4. Understand that granuloma annulare can clear and return. While this skin condition tends to go away on its own without treatment, it also tends to return. Even if you treat it, this skin condition can return. When it returns, it usually clears more quickly.

    5. If you see anything on your skin that is growing, bleeding, or changing in any way, see your dermatologist. Granuloma annulare tends to clear slowly. If you see a sudden change, make an appointment to see your dermatologist. You could have another skin condition.

    Image
    Getty Images

    References
    Ghadially R. “Granuloma annulare.” Medscape. Updated Sep 7, 2017. Last accessed Feb 28, 2018.


    Granuloma annulare
    Granuloma annulare : Overview
    Granuloma annulare : Symptoms
    Granuloma annulare : Causes
    Granuloma annulare : Treatment
    Granuloma annulare : Tips for managing