Granuloma Annulare

What is granuloma annulare?

Granuloma annulare is a common skin rash. Affecting between 0.1% to 0.4% of people, this benign skin condition appears as a raised, discolored ring. While the rash is not particularly harmful, it can last for up to two years before disappearing. For this reason, many people with this condition seek medical treatment to help resolve symptoms. Also known as necrobiotic papulosis, granuloma annulare is more common in young people than in adults, but it can affect people of all ages.

People who suspect they have granuloma annulare should visit a dermatologist. While the condition itself is not dangerous, living with a long-term rash can be difficult. Localized and systemic therapy can help ease symptoms and improve a patient’s quality of life. Additionally, granuloma annulare symptoms overlap with those of more serious conditions, like Lyme disease. Visiting a doctor at the onset of a strange rash is the best way to receive appropriate treatment.

What causes granuloma annulare?

Granuloma annulare is idiopathic, which means it arises spontaneously. In other words, its cause is unknown. However, doctors know that the condition is not contagious. It can occur in people of any age, but it is more common in female bodies than male bodies. Some research suggests that granuloma annulare may be linked to diabetes, but researchers have yet to prove a causal relationship. Additionally, granuloma annulare may be associated with more serious conditions, such as HIV.

Scientists have also found that perforating granuloma annulare, a type of this condition, is common in Hawaii. This points to a possible genetic or environmental link.

Some doctors suspect that granuloma annulare is the result of a hypersensitive reaction to specific triggers. Reported triggers include viral and bacterial skin infections and other forms of skin trauma, like insect stings and tattooing. Additionally, conditions like autoimmune thyroiditis and hyperlipidemia may contribute to granuloma annulare development.

What are the symptoms of granuloma annulare?

Granuloma annulare can present differently depending on a person’s genetics, general health, and environment. But, while there are several types of granuloma annulare, certain symptoms are common across variations:

• Rough, ring-shaped bumps on the skin
• Red, brown, yellow, and/or skin-colored lesions

The rash itself typically has a sunken center and raised bumps that form the ring. Granuloma annulare rarely causes pain or itching, but certain types of the condition can be sensitive to the touch. Lesions can be localized, or they can spread across the body. The American Academy of Dermatology Associate provides detailed photographs for patient reference.

If you suspect that you have granuloma annulare, see a dermatologist. This condition is not often dangerous, but its symptoms overlap with serious conditions. This includes pityriasis rosea, psoriasis, nummular eczema, and Lyme disease. Only receiving a diagnosis from a medical professional can rule out these other conditions. Additionally, seeing a doctor can provide treatment to help minimize symptoms, improving a patient’s quality of life.

What are the types of granuloma annulare?

There are five types of granuloma annulare. It is possible to have more than one type of this condition at the same time. Here’s what you need to know about granuloma annulare variations:

• Localized granuloma annulare: In people with this form of granuloma annulare, the condition is isolated in a specific part of the body. It most often occurs on the knuckles and other joints, like the ankles and elbows. This form of the condition is most common in children. Patients with this type of granuloma annulare may notice small pink bumps on the skin before developing a full rash.
• Generalized/disseminated granuloma annulare: This form of the condition is more common in adults than in children. In generalized granuloma annulare, the rash is more widespread. It often appears in skin folds around the trunk, such as the groin and armpits. It can also occur on forearms and other large swaths of skin. This type of granuloma annulare is associated with itching. This is also most associated with HIV.
• Perforating granuloma annulare: Perforating granuloma annulare appears as yellow papules or plaques. They often form a crust, and they are typically localized. This form of the rash usually forms on the hands, but they can also appear on or around scars. Unlike other forms of granuloma annulare, this rash can be sensitive to the touch. In some cases, these bumps can leak fluid. Perforating granuloma annulare is often widespread, connecting with other lesions to form a larger rash.
• Subcutaneous granuloma annulare: This uncommon form of the condition presents primarily in children. With this rash, individuals develop subcutaneous nodules, or lumps under the skin. The lumps are usually round and firm. They are not typically painful, but they can grow quickly. This most often occurs on the shins, fingertips, and scalp. People often mistake this form of granuloma annulare with rheumatoid arthritis.
• Atypical granuloma annulare: In some cases, granuloma annulare occurs but does not meet the criteria of the four primary variations. When this happens, a patient may receive an atypical granuloma annulare diagnosis. This term describes granuloma annulare that appears in unusual places, like the palms, as well as rashes that are unusually severe or photosensitive.

If you believe you have some form of granuloma annulare, schedule an appointment with your doctor or dermatologist. This is the best and most effective way to alleviate symptoms and rule out other possible skin conditions.

How is granuloma annulare diagnosed?

When you see a doctor for a granuloma annulare diagnosis, they will perform a routine physical exam. Most doctors will also ask standard health history questions. To confirm a diagnosis, a doctor may run a test. Common granuloma annulare diagnostic tests include:

• Skin biopsy: In this noninvasive procedure, the doctor will cut out a small piece of skin. They will then examine the sample for signs of other conditions that may be causing the rash.
• Skin scrape: In this test, the doctor will use a tool to scrape off the top layer of skin. They will then examine the sample under a microscope to determine whether the rash is a result of a fungal or bacterial infection.

In both tests, the patient may wait several days for a result. If a doctor cannot provide a definitive diagnosis after these tests, they may suggest a blood panel to explore other potential causes.

What are granuloma annulare treatments?

There is no cure for granuloma annulare. However, doctors can prescribe various therapies to help mitigate symptoms. Treatment options can be local or systemic, depending on the type of granuloma annulare a patient has. Common therapies include:

• Corticosteroids: Corticosteroids can reduce inflammation and itching. Patients can apply these medications topically, like with a cream or ointment, as an injection, or by pill. Corticosteroids are not intended for long-term use.
• Phototherapy: This treatment utilizes UV light to help reduce the rash. Exposing a patch of skin the UV light can suppress an overactive immune system. This can help reduce symptoms for autoimmune skin conditions, like eczema.
• Cryotherapy: This treatment is designed to “freeze” off the rash using liquid nitrogen. Like with phototherapy, cryotherapy works to boost the immune system. This improves the body’s ability to heal itself.
• Isotretinoin: Often used to treat severe cystic acne, isotretinoin can have an effect on granuloma annulare. The medication works by reducing the size of the skin’s sebaceous glands. This, in turn, helps to reduce irritation and inflammation, which could trigger the rash.
• Antibiotics: Some patients see results with short-term antibiotic treatments. Common prescriptions include minocycline, rifampicin, and ofloxacin.
• Biologics: Biologics are a type of medication developed using materials from living organisms. Many of these medications are relatively new, but they offer a means of treating complex illnesses that do not currently have treatment options.

In some cases, a doctor may prescribe a combination of topical and systemic treatments to reduce granuloma annulare symptoms. If the rash persists, they may recommend a different treatment option.

What is the outlook for people living with granuloma annulare?

In most cases, granuloma annulare will clear on its own. However, this rash is known to persist for several months – sometimes years. Additionally, recurrence is common with granuloma annulare. This is a chronic condition that most patients will encounter several times throughout their lives. Establishing a relationship with a dermatologist, as well as homing in on a treatment method, can improve quality of life after an initial granuloma annulare diagnosis.

Remember that granuloma annulare symptoms often overlap with other, more serious conditions. Some people who believe they have this benign skin condition may actually have Lyme disease. If you have any ring-shaped lesions on your body, it is important to visit a doctor as soon as possible. Then, depending on the diagnosis, you can get the treatment you need.

In general, people with granuloma annulare lead normal, healthy lives. Once other potential diagnoses are ruled out, you can begin a treatment regimen with your doctor. If you suspect you have this condition, contact a dermatologist today. Starting treatment can help alleviate the stress – and discomfort – of having a skin lesion.