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Granuloma Annulare

Disseminated Granuloma Annulare

It is a chronic skin disease, characterized by small to large elevated bumps that form a ring with a normal or sunken center. It normally doesn’t itch. The cause of Granuloma Annulare is unknown, and it is considered harmless. The condition mostly affects adults under 30 years and children. People who have diabetes are more prone to suffer from the condition. Women are affected more than men. Lichen Annularis is sometimes used as synonym.

Causes of Granuloma Annulare

The cause is unknown but it is associated with diabetes, tuberculosis, insect bites, sun exposure, trauma and viral infections such as HIV, Epstein Barr virus, and the herpes zoster virus. It may be hereditary in some cases, as it has been reported in twin siblings and people with a family history of Granuloma Annulare. An internal disease doesn’t cause it.

How does look Granuloma Annulare?

It is often confused with ringworm and insect bites, or the start of Lyme disease. It may be yellow, red, purple or white and starts as a smooth bump that expands to a circular ring with a red border and a clear center. It usually doesn’t burn or itch and can go unnoticed except for its appearance.

Symptoms of the condition

The symptoms may vary from person to person but the common signs include:

  1. One or more bumps on the hands, feet, legs, and arms.
  2. Yellowish skin color bumps.
  3. The lesions improve during the winter months and worsen again at the start of summer.
  4. Grouped bumps may expand to annular bumps ranging in size from 1-6 centimeters in diameter.
  5. The bumps may in rare cases appear on the penis and face.
  6. The papules don’t scale or hurt.
  7. Papules around the ring are close but don’t grow together.

Diagnosis for Granuloma Annulare

The doctor does a visual examination of the skin, reviews your history of diabetes and takes a skin sample.

Treatment for Granuloma Annulare

  1. It is in most cases unnecessary for any treatment.
  2. Topical cortisone preparations provide limited results.
  3. Cortisone injections are more effective than the creams.
  4. PUVA light therapy can be used, though it has the side effect of sunburn symptoms on surrounding skin areas.
  5. Tranilast application for a period of three months may reduce the appearance of Granuloma Annulare
  6. In the majority of cases, it disappears on its own after two years.

Specific treatment for the condition depends on the patient’s health, history and age, the severity of the condition, tolerance to specific therapies and medications, and the patient’s own opinion. The use of steroid creams or injections should be monitored since the long-term use can result in the thinning of the skin. If the appearance is undesirable, you can have it surgically removed with laser treatment. The laser treatment is safe but will cause discomfort for three weeks. Granuloma Annulare cures after two years, but can disappear faster with treatment.

When you apply steroid creams, only rub a small amount on the affected areas and cover the skin with clear kitchen plastic wrap to keep it moisturized. You can also soak the affected area for a brief period under water after treatment. Reapply the steroid cream every time you change the dressing.

There are no limitations on activities that you can do. Since it normally doesn’t itch, you can wear clothing over it. Keep the skin moisturized and avoid excessive heat or sun exposure. Avoid possible injuries to the skin.

You can try to apply vinegar to the affected areas for a period of 30 days. Keep it on the papules for 15 minutes at a time. The acid seems to reduce the appearance of Granuloma Annulare.

Prevention of Granuloma Annulare

There are no methods to prevent the outbreak of the condition other than reducing skin exposure to sun and to follow a balanced diet of no wheat products. The consumption of Romaine lettuce daily has worked for some people, but once they stopped, the condition just returned.

Granuloma Annulare is one of those rare skin conditions that only affect a few people and for which scientists still have no permanent cure, mainly because the cause is still unknown. It is harmless and clears up on its own in most cases, though some people may require steroid creams or laser PUVA therapy to fasten the healing process.


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