What Is Granuloma Annulare?
Granuloma annulare is a benign, or non-cancerous, often long-lasting or chronic skin disorder characterized by inflammation, which causes raised, discolored rashes, bumps, or lumps under the skin. In many situations, skin granuloma rashes form on the hands, feet, and forearms. This condition most commonly affects children and young adults, though it can affect people of any age. Women are typically affected more often than men. Perforating granuloma annulare is more common among people in Hawaii. Granuloma inflammation, and the disease in general, is not contagious, and the condition is not cancerous.
The rash produced can either be localized or generalized. Localized granuloma annulare is the most common type and usually affects the forearms, hands, or feet. This generalized form presents numerous erythematous lesions or papules that produce large, raised plaques anywhere on the body, including the soles of the feet and the palms of the hands. Here, the patches may or may not occur in a ring pattern, and the lesions can vary in color. Less common types of granuloma annulare include subcutaneous granuloma annulare, perforating granuloma annulare, and patch granuloma annulare. Contact Advanced Dermatology and Skin Cancer Center to learn more.
What Causes Granuloma Annulare?
Granuloma annulare causes are not known, however, some research indicates the immune system may play a role in the skin condition's development. Other research points to a relation between granuloma annulare and certain triggers, such as skin injuries, insect bites or skin trauma, certain medications, and some diseases, like human immunodeficiency virus (HIV) and hepatitis C. Some individuals develop this condition after exposure to certain environmental triggers, such as long-term sun exposure. However, not everyone who experiences these triggers will develop granuloma annulare. Granuloma annulare often appears in those who injure their skin. Because it doesn't develop in everyone who injures their skin, it is possible that those who develop granuloma annulare are sensitive to whatever caused the injury.
Types Of Granuloma Annulare
There are five main types of granuloma annulare: localized granuloma annulare, generalized granuloma annulare, subcutaneous granuloma annulare, perforating granuloma annulare, and patch granuloma annulare. People can develop more than one type of granuloma annulare at the same time. Contact our office for more information about these conditions.
Localized Granuloma Annulare
Localized granuloma annulare is the most common variation of this condition. It causes a circular rash on the skin, and patients may notice several small bumps before they develop a rash, which can appear red, pink, purple, or the natural color of the surrounding skin.
Generalized Granuloma Annulare
Generalized granuloma annulare is characterized by bumps over a large area of the body, such as the whole forearm, instead of a smaller, more concentrated rash that appears in a more condensed space. The bumps that develop eventually merge and form large, discolored areas of skin.
Subcutaneous Granuloma Annulare
Subcutaneous granuloma annulare causes lumps to develop under the skin. These lesions are usually firm to the touch and round. Despite their appearance, these bumps are not painful and often remain a small size, though they have been known to grow larger quickly. These lumps can be red, pink, or skin-colored.
Perforating Granuloma Annulare
Perforating granuloma annulare is marked by small, painful, scaly bumps on the hands and fingers .The bumps can sometimes be itchy, painful, or otherwise cause discomfort. Some individuals with this type of granuloma annulare develop widespread bumps that connect to form larger rashes.
Patch Granuloma Annulare
Patch granuloma annulare is characterized by red, red-brown, or purple-colored lesions with flat areas of rash forming on the skin. Individuals diagnosed with patch granuloma annulare can develop one or more areas of skin with these lesions and rashes. This is an uncommon granuloma annulare variant typically appearing on the extremities and trunk.
Granuloma Annulare Symptoms
The signs and symptoms of granuloma annulare can vary, depending on the type. Additionally, individuals may experience symptoms differently, even with the same diagnosis. However, for most people, granuloma annulare causes no symptoms other than a rash or a lump under the skin. Some people may experience these symptoms as well as pain, tenderness, and itchiness in the affected area of skin. This condition may affect an individual anywhere on their body, though the most commonly affected areas of the fingers, hands, and feet. In most cases, both sides of the body are affected, making the rashes or lesions symmetrical. Other commonly affected areas include the forehead, neck, and abdomen, among other parts of the body.
Localized variations of this condition normally affects one specific area of the body, while generalized or disseminated granuloma annulare can affect more than one parts of the body at one time. Bumps associated with this form are more numerous than with localized granuloma annulare, and they can be itchy. Subcutaneous granuloma annulare can develop as a single, painless lump under the skin (subcutaneous), with the scalp, arms, and legs most often affected. With perforating granuloma annulare, bumps or pustules develop a yellow center which can leak a clear fluid, becoming crusty and eventually leaving a scar once the lesion disappears. In this type, the lesions can merge to form larger plaques. Patch granuloma annulare is a very rare form of the disease that primarily affects the trunk, core, and extremities, such as the fingers and toes.
What Triggers Granuloma Annulare?
Granuloma annulare is sometimes associated with diabetes and thyroid disease, particularly when the lesions are numerous or widespread. Rarely, it is related to cancer, specifically in older individuals with severe cases that don't respond to treatment or cases where the disease returns following treatment for their cancer. Doctors think granuloma annulare may be related to triggers, such as skin injuries, including insect bites or stings and skin trauma; certain medications, such as allopurinol; and some diseases, like HIV and hepatitis C, among other conditions. For more information about granuloma annulare triggers, please contact our office.
How Is Granuloma Annulare Diagnosed?
To diagnose granuloma annulare, your doctor will examine your skin. Your doctor may also choose to take a sample of your skin, or a skin biopsy, to confirm your diagnosis and to rule out any other diseases or conditions. For many people, this condition goes away on its own and without treatment within about two years of developing. However, in some individuals, the rash can recur after it disappears. If granuloma annulare causes large rashes to appear on your skin, if there are deep lesions in your skin, or large lumps under your skin, you likely require treatment from your Boardman dermatologist.
Granuloma Annulare Treatment
The primary goal of granuloma annulare treatment is to help control the symptoms of this condition, such as itching or pain. Additionally, treatments can speed up the time it takes for your rash to fade or dissipate, though this is not always seen in all patients. The specific treatment you will receive will be determined by your physician during your appointment. Medications, such as corticosteroids, isotretinoin, or tacrolimus, may help clear your skin by reducing inflammation in your body. Other medications, such as those used to treat malaria, can help reduce the appearance of the rash or lesions on your skin.
PUVA therapy, sometimes called photochemotherapy, is a form of light therapy that uses psoralen, a drug either taken orally or given as a soak, followed by exposure of the affected skin to UVA light. UV light can slow down the growth of skin cells, which might help the condition from growing. Cryotherapy uses special equipment to freeze the area of the skin affected by granuloma annulare in an attempt to halt the growth of skin lesions or patches. Laser therapy uses specialized medical lasers to target and heat the skin to decrease inflammation within the skin and prevent further spreading of the rash to other areas of the body.
For some people with granuloma annulare, their condition can be difficult to treat. Some patients may try several different therapies before finding the treatment that best suits their needs.