Granuloma Annulare – Causes, Symptoms, Treatment, Types, Pictures

Granuloma annulare is a skin disorder that caused raised lesions on the hands and feet. It is a rare skin condition causing itchy skin. What exactly triggers this condition is not known, but often the lesions are harmless and disappear without wanting any treatment. GA can occur in any age group and sex and is categorized under dermatosis.

Granuloma Annulare Types :

There are 4 types of granuloma annulare (GA) differing in the aspect of size and the site it occurs on the body.

1. Localized – This form causes skin or flesh colored lesions that measure roughly 5cm in diameter. It exists in the form of distinct ring like pattern on the upper surface of the skin or epidermis. Localized GA is often seen on the wrists, lower limbs, ankles and the feet like annular rings with raised papules in it.
2. Generalized – This kind of GA occurs in adults commonly. It can occur anywhere in the body as the name suggests, but is often marked to extremities (hands and feet), face and neck. The lesions appear as annular plaques showing variations in color from pink to violet.
3. Subcutaneous GA – This kind commonly occurs in children in the form of firm, raised nodules in the deep dermis region. The size of each lesion may range from 5mm to 4cm in circumference and is largely seen on the areas of hands, feet, ankles, buttocks, eyelids and even on the head.
4. Perforating GA – It is a rare kind of GA restricting to hands and fingers causing raised bumps oozing out fluid and leaves a scar after healing.

Symptoms :

• Symptoms of GA vary as per the type and the site of infection.
• The bumps or lesions are round shaped with raised defined patches seen on the feet and hands of the affected person. In some children it can occur on the ankles and wrists.
• Generalized GA can be itchy and painful which occurs largely on the arms, legs and trunk.
• Subcutaneous GA occurs under the skin of young children and spreads like that of a rash. Here the lesions are smaller in size and it can be itchy.
• The color of the lesions may range from skin color to orange and dark pink.

Causes of Granuloma Annulare :

What triggers lesion due to GA is not known. It can be caused by many factors that act as triggering agents. Lesions can occur after skin infections, insect bites, and excess of exposure to sun and due to allergy caused by vaccination. TB skin test can also trigger this reaction. Several kinds of viral infection can also cause papules or lesions on the skin. Granuloma annulare do not spread to others by touching.

Risk Factors :

• Anyone can develop GA but people with weakened immunity and with chronic diseases are more prone than others.
• Individuals with Type 1 diabetes, HIV infection, Hodgkin lymphoma and other types of cancer are at increased risk of developing GA.
• People with history of viral infections like hepatitis infection and thyroid problems can get GA.
• When compared with men, women are at increased risk for GA.
• Children are more prone to develop localized GA and are also commonly seen in adults below 30 years. Aged people are at risk of developing generalized form.

Diagnosis :

The doctor can detect GA by examining the affected skin. Biopsy (small tissue sample) can be done and examined in the lab settings to confirm the diagnosis.

Treatment :

• Often GA does not require any medical treatment, since the lesions resolve after few weeks or months.
• For severe cases of lesions with itchiness and pain, medications are available.
• Topical creams that contain steroid are recommended to improve the symptoms. Cream is liberally applied on the lesions or bumps and covered with bandages. Within few days the lesions would disappear from the skin.
• Corticosteroids cream like clobetasol, Triamcinolone and Prednisone ointment are largely prescribed.
• Retinoids like Accutane or Isotretinoin are given for treating severe form of GA. In some cases psoralen phototherapy agents like methoxsalen plus are suggested.
• In rare cases corticosteroid injection is given directly in the lesions to get quick results. Some doctors use cryotherapy method in which liquid nitrogen is used on the lesions for removing them permanently.
• Phototherapy can also be done by passing specific beam of light directly into the lesions. Supplementary oral pills are also given for the patients if the lesions are widespread.
• Laser therapy is also used for treating lesions in the localized and generalized form of GA.

Outlook :

Prognosis of GA differs in every person. There are cases wherein the lesions have disappeared within weeks and some cases where treatment is taken for months together. There is a 40% chance of recurrence of lesions. When comparing with localized form, generalized granuloma is difficult to treat since the response is very poor and it takes long term for complete healing.