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Granuloma Annulare: Types, Causes, Symptoms, Diagnosis And Treatment

Granuloma annulare is a rare and chronic skin condition that causes reddish or skin coloured bumps in a ring pattern. It is not contagious nor cancerous and can occur at any age. The condition is commonly found in women and usually develops on the hands and the feet.

The bumps or the lesions are commonly found on the skin that coves joints like elbows or knuckles. In some cases, the bumps can also appear on the backside of your hands and also on top of the feet [1] .

Most cases of granuloma annulare have been reported in healthy people. The lesions caused by the condition usually disappear on their own within two years without treatment. The benign inflammatory disease has been linked with diabetes mellitus [2] .

Granuloma annulare sometimes get mistaken for skin conditions such as nummular eczema, psoriasis, tinea corporis etc. The aetiology of the genetic disorder is unknown [2] .

Types Of Granuloma Annulare

The genetic condition is classified into different types depending on its location and age-group affected. The clinical variants of granuloma annulare as follows [3] [4] :

Localised granuloma annulare: The most common form of the genetic condition, localised granuloma annulare affects children and young to middle-aged adults. It appears on the elbows, fingers, hands, ankles and dorsal feet.

Generalised granuloma annulare: This type is mostly found in adults and affects the neck, trunk, face, scalp, soles and palms. The lesions can be papules spread throughout the affected area or annular and large plaques.

Subcutaneous granuloma annulare: This type of granuloma annulare is commonly found in children and are found on the ankles, dorsal feet, buttocks, hands, scalp, and eyelids.

Perforating granuloma annulare: This one is rare and appears on the dorsal hands. It has been linked with diabetes mellitus, thyroid disease, malignancies and drug allergies.

Arcuate dermal erythema: Another rare type of granuloma annulare, this one develops are large, hyperpigmented rings with central clearing.

Causes Of Granuloma Annulare

To date, doctors and medical experts have not been able to point out the exact specific reason for granuloma annulare. However, the following can trigger it [5] :

  • Drugs
  • Animal or insect bites
  • Infections, such as hepatitis
  • Minor skin injuries
  • Exposure to sun
  • Tuberculin skin tests
  • Vaccinations

Normally reported in healthy individuals, the condition may be associated with diabetes or thyroid disease [6] .

It has also been linked to auto-immune diseases like Addison's disease, systemic lupus erythematosus, rheumatoid arthritis, Lyme disease.

Symptoms Of Granuloma Annulare

The signs of granuloma annulare can vary according to the type of condition [7] .

In the case of localised granuloma annulare, the symptoms are reddish or skin coloured bumps on the hands, feet, wrists and ankles of young adults.

In generalised granuloma annulare, the symptoms are itchy reddish or skin coloured bumps on most of the body, including the trunk, arms and leg [8] .

Granuloma annulare that develops under the skin develops small and firm lumps under the skin. It is found on the hands, scalp and shins.

Diagnosis For Granuloma Annulare

To understand the severity of the condition, the doctor will begin by examining the affected skin. A small skin sample will be taken to examine under a microscope [9] .

Treatment For Granuloma Annulare

In most cases, medical care is not necessary as most bumps disappear in a few months and rarely last more than two years.

But if the bumps or rashes become too itchy or if you are uncomfortable with it being on your skin, discuss a suitable treatment method with your doctor. The treatments adopted for granuloma annulare are as follows [10] :

  • Corticosteroid creams or ointments
  • Corticosteroid injections
  • Oral medications
  • Freezing (by applying liquid nitrogen)
  • Light therapy
View Article References
  1. [1] Piette, E. W., & Rosenbach, M. (2016). Granuloma annulare: clinical and histologic variants, epidemiology, and genetics. Journal of the American Academy of Dermatology, 75(3), 457-465.
  2. [2] Piette, E. W., & Rosenbach, M. (2016). Granuloma annulare: pathogenesis, disease associations and triggers, and therapeutic options. Journal of the American Academy of Dermatology, 75(3), 467-479.
  3. [3] Keimig, E. L. (2015). Granuloma annulare. Dermatologic clinics, 33(3), 315-329.
  4. [4] Wu, J., Kwong, B. Y., Martires, K. J., Rieger, K. E., Chung, W. H., Iyer, G. V., & Lacouture, M. E. (2018). Granuloma annulare associated with immune checkpoint inhibitors. Journal of the European Academy of Dermatology and Venereology: JEADV, 32(4), e124-e126.
  5. [5] Ronen, S., Rothschild, M., & Suster, S. (2019). The interstitial variant of granuloma annulare: clinicopathologic study of 69 cases with a comparison with conventional granuloma annulare. Journal of cutaneous pathology.
  6. [6] Pelechas, E., Papoudou-Bai, A., Voulgari, P. V., & Drosos, A. A. (2019). Granuloma annulare development in a patient with rheumatoid arthritis treated with tocilizumab: case-based review. Rheumatology international, 39(2), 353-357.
  7. [7] Mangold, A. R., Cumsky, H. J., Costello, C. M., Xie, D. Y., Buras, M. R., Nelson, S. A., ... & Pittelkow, M. R. (2018). Clinical and histopathologic features of paraneoplastic granuloma annulare in association with solid organ malignancies: A case–control study. Journal of the American Academy of Dermatology, 79(5), 913-920.
  8. [8] Al Ali, A., Alkhodair, R., Thuraisingam, T., Gerstein, W., & Watters, K. (2018). Multiple granuloma annulare lesions presenting simultaneously with herpes zoster infection: Wolf's isotopic response. JAAD case reports, 4(7), 631-632.
  9. [9] Wang, J., & Khachemoune, A. (2018). Granuloma annulare: a focused review of therapeutic options. American journal of clinical dermatology, 19(3), 333-344.
  10. [10] Aichelburg, M. C., Pinkowicz, A., Schuster, C., Volc‐Platzer, B., & Tanew, A. (2019). Patch granuloma annulare: clinicopathological characteristics and response to phototherapy. British Journal of Dermatology.

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