granuloma annulare

What is Granuloma Annulare?

Granuloma annulare (GA) is a benign skin condition characterized by the presence of small, raised bumps that form a ring with a normal or sunken center. It is a common non-infectious granulomatous disease of unknown etiology [10].

Types of Granuloma Annulare

There are several types of GA, including:

• Localized: This is the most common type, where the rash borders are circular or semicircular, with a diameter up to 2 inches (5 centimeters) [1].
• Generalized (disseminated): Bumps develop over a larger area of your skin, like your whole forearm [2].
• Subcutaneous: Lumps form under the skin [3].

Symptoms and Signs

The most common symptom is small circular patches of pink, purple or skin-coloured bumps on the skin [5]. The rash can occur on various parts of the body, including hands, feet, wrists, and ankles [1].

Causes and Associations

The cause of GA is unknown, but doctors suspect it is the result of an immune system reaction [13]. It has been associated with several factors, including diabetes or thyroid disease, but having GA does not mean that another disorder is present [11].

Distinguishing from Other Conditions

GA can be mistaken for other common annular skin conditions such as tinea corporis, pityriasis rosea, nummular eczema, psoriasis, or erythema migrans of Lyme disease [15].

Common Signs and Symptoms of Granuloma Annulare

Granuloma annulare is a skin condition that can cause a range of symptoms, which may vary from person to person. Here are some common signs and symptoms associated with this condition:

• Raised Rash or Bumps: The most common symptom of granuloma annulare is the presence of raised, discolored rash or lumps on the skin [1].
• Small Circular Patches: The patches can be pink, purple, or skin-colored bumps that are roughly in the shape of a ring [4].
• Firm Bumps: The bumps may feel firm to the touch and can be red, yellow, or other colors [6].
• Itching or Pain: Some people may experience itching, pain, or tenderness when knocked on the affected areas [7].
• Scaly Texture: In some cases, the bumps may have a scaly texture [5].

Variations in Symptoms

Symptoms can occur differently in each person. For example:

• The ring-shaped patches may be red, yellow, or other colors.
• The bumps may leak fluid, itch, or feel painful.
• Some people may experience no symptoms at all.

Rare Types of Granuloma Annulare

There are rare types of granuloma annulare that can cause additional symptoms, such as:

• Generalized Granuloma Annulare: This type usually develops on the hands and fingers and causes small bumps that often feel scaly [5].
• Localized Granuloma Annulare: This is the most common form, characterized by small, firm red or yellow-colored bumps (nodules) [3].

References

[1] Oct 23, 2024 — Granuloma annulare. [2] Nov 15, 2022 — Granuloma annulare is a long-lasting skin disorder. [3] Feb 21, 2008 — The most common form is localized granuloma annulare... [4] The most common symptom is small circular patches of pink, purple or skin-coloured bumps on the skin. [5] This rare type usually develops on the hands and fingers. [6] Symptoms can occur a bit differently in each person. [7] It only affects the skin.

Diagnostic Tests for Granuloma Annulare

Granuloma annulare (GA) is a skin condition that can be diagnosed through a combination of clinical examination, medical history, and diagnostic tests.

• Physical Examination: A healthcare provider will perform a physical examination of the affected skin to look for characteristic features such as small, pale bumps or rings. [2][4]
• Skin Biopsy: In some cases, a skin biopsy may be performed to confirm the diagnosis. This involves removing a small sample of skin tissue and examining it under a microscope. [5][6][7]
• Skin Scraping: A healthcare provider may also perform a skin scraping test, where they scrape the top layer of skin with a small tool and examine the scraped tissue under a microscope. [9]

Imaging Studies

While imaging studies are not generally necessary for diagnosing granuloma annulare, they may be helpful in some cases to rule out other conditions or to assess the extent of the disease.

• Radiographs: X-rays may be taken to evaluate the skin and underlying tissues.
• CT Scans: Computed tomography (CT) scans may be used to visualize the skin and underlying structures.
• MRIs: Magnetic resonance imaging (MRI) scans may also be performed to assess the skin and underlying tissues.

Consultation with a Dermatologist

It is essential to consult with a dermatologist for an accurate diagnosis of granuloma annulare. They will evaluate your medical history, perform a physical examination, and may recommend diagnostic tests as needed.

References:

[1] Oct 15, 2020 — Imaging studies are not generally necessary in diagnosing granuloma annulare. [2] How do dermatologists diagnose granuloma annulare? [3] by PR CYR · 2006 · Cited by 184 — Treatment for disseminated granuloma annulare should be undertaken in consultation with a dermatologist; [4] Nov 15, 2022 — A healthcare provider will perform a physical examination of your skin. [5] by EW Piette · 2015 · Cited by 191 — A dermatologist can often diagnose granuloma annulare without any further testing. [6] How is granuloma annulare diagnosed? [7] by LA Thornsberry · 2013 · Cited by 225 — The diagnosis of GA relies on clinicopathological correlation, with a skin biopsy confirming the histological features of the disease, [8] Granuloma annulare is usually diagnosed clinically because of its characteristic appearance. [9] Skin scraping. The healthcare provider scrapes the top of your skin with a small tool.

Treatment Options for Granuloma Annulare

Granuloma annulare (GA) is a skin condition characterized by the formation of small, rounded bumps or lesions on the skin. While there are various treatment options available, the most effective approach often depends on the severity and location of the lesions.

• Corticosteroids: These medications can be applied topically to reduce inflammation and promote healing. In some cases, oral corticosteroids may be prescribed for more severe or widespread GA.
  • Corticosteroid creams or ointments (e.g., prescription-strength products) can help clear the skin faster [2].
  • Corticosteroid injections may also be used to treat localized lesions [3].
• Isotretinoin: This medication, also known as Accutane, is sometimes prescribed for severe GA that has not responded to other treatments.
  • Isotretinoin can help reduce the size and number of lesions, but it may have significant side effects [4].
• Tacrolimus: This topical cream or ointment can be used to treat localized GA by reducing inflammation and promoting healing.
  • Tacrolimus has been shown to be effective in treating GA, especially when combined with other treatments [5].
• Other medications: In some cases, other medications such as rifampin, ofloxacin, and minocycline may be prescribed for GA that is resistant to other treatments.

Key Statistics

• According to a study published in 2011, oral corticosteroids were found to be effective in treating severe GA [8].
• A survey conducted in 2006-2007 reported that topical steroids were the most commonly used treatment for GA, followed by antifungals and antibiotics [10].

References

[2] Oct 23, 2024 — Treatment · Corticosteroid creams or ointments. Prescription-strength products may help clear the skin faster. [3] Oct 15, 2020 — Localized lesions have been treated with potent topical corticosteroids with or without occlusion for 4-6 weeks, as well as with intralesional injections. [4] Nov 15, 2022 — Your healthcare provider may recommend corticosteroids, isotretinoin (Absorica®, Zenatane®) or tacrolimus (Protopic®). [5] by DV Marcus · 2009 · Cited by 71 — Granuloma annulare treated with rifampin, ofloxacin, and minocycline combination therapy. [8] by H Kozic · 2011 · Cited by 28 — Widespread granuloma annulare (GA) can be a difficult disease to treat. Often the only drug that is effective in severe disease is an oral corticosteroid, which ... [10] Result: | male | female | all topical antifungals | 15% | 39% | 27% topical steroids | 37% | 9.5% | 23% topical antibiotics | 41% | 0% | 21% miscellaneous topical agents | 31% | 3.8% | 18% azole antifungals | 23% | 7.3% | 15%

Differential Diagnosis of Granuloma Annulare

Granuloma annulare (GA) can be mistaken for other common annular skin conditions, such as:

• Tinea corporis: This fungal infection can present with similar annular lesions, but GA typically lacks surface scale [2].
• Pityriasis rosea: This condition is characterized by oval-shaped patches, but GA tends to have a more indurated border and is often found on the extremities [3].
• Acute febrile neutrophilic dermatosis: Also known as Sweet's syndrome, this condition presents with fever, leukocytosis, and tender erythematous papules or plaques, which can be mistaken for GA in its early stages.
• Erythema annulare centrifugum: This condition is characterized by a ring-shaped rash that spreads outward from the center, similar to GA.

Other conditions that may be considered in the differential diagnosis of granuloma annulare include:

• Necrobiotic xanthogranuloma (NBL): A rare skin disorder characterized by granulomatous inflammation and necrosis.
• Sarcoidosis: A systemic disease that can affect multiple organs, including the skin, where it presents with non-caseating granulomas.
• Rheumatoid nodule: A type of skin lesion associated with rheumatoid arthritis.

It's essential to consider these differential diagnoses when evaluating patients with suspected granuloma annulare, as accurate diagnosis and treatment can significantly impact patient outcomes [8].

References: [2] - PR CYR (2006) [3] - PR CYR (2006) [8] - D Chatterjee (2018)