Granuloma Annulare

Granuloma annulare is a long-term ( chronic ) skin disease consisting of a rash with reddish bumps arranged in a circle or ring. It appears most often over knuckles and other joints or in places that are subject to frequent, mild injury such as the back of the hands or top of the feet. GA may be localized, generalized, perforating, or subcutaneous. Lesions of the first 3 presentations have similar appearances, but each one follows a distinctive clinical course. Granuloma annulare is a benign inflammatory dermatosis characterized clinically by dermal papules and annular plaques. Its precise cause is unknown. Patients usually notice a ring of small, firm bumps (papules) over the backs of the forearms, hands or feet. Occasionally, multiple rings may be found. In a few people, clusters of granuloma annulare bumps erupt when the skin is exposed to the sun. Granuloma annulare may be pearly white, skin-colored, red, or purple. It is most often an isolated area, but may appear as several "bumps" spread all over the body. It is often seen on the tops of the hands and feet, elbows, and knees. Granuloma annulare may cause no symptoms, but affected areas are often tender when knocked.

Granuloma annulare is a chronic degenerative skin disorder. GA is occasionally quite widespread (generalized GA) and this may be an entirely different condition. In these cases the bumps are often smaller and the rings harder to see. PG is a disorder of angiogenesis whose underlying etiology remains unknown. Subcutaneous GA most often manifests as a large, asymptomatic soft tissue mass. Although nodules are usually stable for months, they may rapidly enlarge over the course of weeks. A predilection exists for the head and neck, although lesions may appear on any part of the body. GA has been epidemiologically linked to diabetes mellitus, necrobiosis lipoidica diabeticorum, and rheumatoid nodules. Because granuloma annulare is usually asymptomatic, treatment may not be necessary except for cosmetic reasons. Most lesions of granuloma annulare disappear with no treatment within two years. Women are affected twice as often as men. The localised variety is usually found under 30 years old. The generalised type has peaks at under 10 and 30 to 60 years. People with large affected areas often benefit from treatment that combines phototherapy (exposure to ultraviolet light) with the use of psoralens (drugs that make the skin more sensitive to the effects of ultraviolet light).

Causes of Granuloma annulare

The common causes and risk factor's of Granuloma annulare include the following:

• The exect cause of granuloma annulare is unknown.
• Granuloma annulare most often affects children and young adults. It is slightly more common in girls.
• The condition is usually seen in otherwise healthy people.
• Some types of granuloma annulare have been linked with diabetes but this is very uncommon in the ordinary type.

Symptoms of Granuloma annulare

Some sign and symptoms related to Granuloma annulare are as follows:

• Patients usually notice a ring of small, firm bumps (papules) over the backs of the forearms, hands or feet.
• Ringed red bumps on soles of feet.
• Mild itching in some people, though the lesions usually cause no pain or itching.
• Yellowish or skin-colored bumps.
• Ringed red bumps on back of hands.
• Multiple rings may be found.
• Ringed red bumps on elbows.
• A skin biopsy may also be necessary to confirm the diagnosis of granuloma annulare.

Treatment of Granuloma annulare

Here is list of the methods for treating Granuloma annulare:

• Very strong topical steroid creams or ointments are sometimes used to speed the disappearance of the lesions.
• Injections of steroids directly into the rings may also be effective.
• Light therapy: In severe cases of generalized granuloma annulare, your doctor may recommend a special kind of ultraviolet light therapy called psoralen plus ultraviolet A (PUVA).
• In severe cases oral medications may be needed.
• Freezing the spots with liquid nitrogen works well, but can leave pigmentation changes.
• In cryotherapy, your doctor applies liquid nitrogen to the affected area with a cotton-tipped applicator or a small instrument designed for applying extreme cold (a spray device or a cryoprobe).

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