What is Granuloma Annulare?
Granuloma annulare (GA) is a skin condition with an unknown cause, commonly characterized by a non-infectious inflammation. It’s the most prevalent type of non-infectious inflammation condition of skin. While generally harmless and tends to go away on its own, Granuloma annulare can be recognized by red patches or small raised areas on the skin often shaped like a ring, usually found on the upper body parts.
Besides the usual form of granuloma annulare, there are other types such as generalized, perforating, patch, and subcutaneous. Even though it’s not harmful, it can be connected with more serious health conditions like HIV or cancer.
What Causes Granuloma Annulare?
Granuloma annulare is a skin condition and we don’t yet fully understand what causes it. It has, however, been linked with several other conditions and factors, like diabetes, thyroid disease, minor injuries, high cholesterol, certain infections such as the Epstein-Barr Virus or HIV, vaccines, and even some drugs (like TNF-alpha inhibitors).
Whilst there’s a common belief that diabetes plays a role, we currently don’t have enough evidence to fully support this. In some cases, doctors might want to check for any signs of cancer in a patient with granuloma annulare. This is usually when the person is older, their symptoms aren’t typical or are widespread, or their condition doesn’t get better with treatment. Nevertheless, there is still a need for more research to understand the true relationship between granuloma annulare and cancer.
Studies suggest that people with HIV are more likely to have a wide-spread version of granuloma annulare. In addition, some reports indicate a few unusual cases of granuloma annulare in patients with HIV. There are also instances where antiretroviral drugs, typically used to manage HIV, have both improved and worsened the condition. It’s recommended that new patients with granuloma annulare who are at risk of HIV, as well as those presenting with a widespread or severe form of the condition, should be checked for HIV.
Risk Factors and Frequency for Granuloma Annulare
Granuloma annulare is a condition that affects about 0.1% to 0.4% of people. Women are more likely to be affected than men, and it can affect people of all ages. However, the majority of cases, specifically more than two-thirds, are found in individuals who are 30 years old or younger.
- Granuloma annulare affects about 0.1% to 0.4% of people.
- Women are more commonly affected than men.
- This condition can happen to anyone, regardless of age.
- Yet, more than two-thirds of cases occur in people 30 years old or younger.
Signs and Symptoms of Granuloma Annulare
: Granuloma annulare is a skin condition that typically appears on the sides and back of the hands and feet in a ring-shaped pattern. Most people with the condition don’t experience itching or other symptoms with these skin lesions. The most common type of granuloma annulare, called the ‘localized variant’, represents about 75% of all cases of this condition.
This health condition is not limited to just one type. There are a few more variants of granuloma annulare, including:
- Generalized granuloma annulare
- Perforating granuloma annulare
- Patch granuloma annulare
- Subcutaneous granuloma annulare
‘Generalized granuloma annulare’ is characterized by many flesh-colored bumps in a ring pattern on the body and limbs – unlike the typical, these lesions often itch. Around 15% of all cases are of this particular subtype, which is less likely to improve on its own and is not highly responsive to treatment.
‘Subcutaneous granuloma annulare’ manifests as large skin bumps on the limbs. It’s mostly seen in children, particularly those aged one to fourteen years.
The ‘patch variant’ of granuloma annulare is characterized by red skin patches, possibly covering large areas of skin, which can be easily confused with reactive granulomatous eruptions. ‘Perforating granuloma annulare’ is marked by dimpled skin bumps, which may be limited to the limbs or may involve the body and limbs.
Around half of the patients with the localized form of granuloma annulare naturally get better within two years. Also, a person can have more than one type of this skin condition.
Testing for Granuloma Annulare
Diagnosing Granuloma annulare, a skin condition, involves two main steps. The first step is examining the physical symptoms or how the skin condition appears (as mentioned earlier). The second step involves taking a small sample of skin (biopsy) and studying it under a microscope to examine its physical and cellular characteristics (as mentioned earlier). Through these two steps, doctor can confirm the diagnosis of Granuloma annulare.
Treatment Options for Granuloma Annulare
Granuloma annulare is a condition characterized by small, raised bumps (lesions) that form a circular, or ring, pattern. Although these lesions normally heal on their own, they may reappear. Treatment is sometimes necessary, particularly if the appearance of the lesions concern the patient.
Unfortunately, there is not a lot of research-backed evidence supporting the effectiveness of many of the treatments physicians try. For instance, in one study with 67 patients having granuloma annulare, they found that there was no big difference in terms of how long the lesions lasted between those patients treated and those untreated.
Despite this, medical experts generally agree that starting treatment with an injection of steroids into the lesions (intralesional steroid injection) is the preferred first step. Some improvement has been reported after the lesions have been disturbed, such as being biopsied, pricked, or incised, and even after being treated with cold therapy (cryotherapy).
Phototherapy, which involves using ultraviolet light to treat the skin, has demonstrated promising results in some studies. Success has also been reported with excimer laser and pulsed dye laser, both of which use focused light to target and treat the skin.
The drug hydroxychloroquine has shown promise in some small studies, leading some experts to suggest that this should be the first treatment choice for widespread granuloma annulare. Another promising treatment method is the use of drugs known as tumor necrosis factor-alpha inhibitors. However, additional research is needed since these inhibitors may potentially trigger or worsen the disease.
Doctors have also tried removing the lesions surgically but they tend to reappear afterwards.
There are also additional treatments that physicians have explored including vitamin E, isotretinoin, tetracyclines, intralesional interferons, topical imiquimod, niacinamide, oral calcitriol, dapsone, hydroxyurea, topical tacrolimus, clofazimine, and rifampin. These treatments have reportedly been somewhat effective in small studies.
What else can Granuloma Annulare be?
Here is a list of various medical conditions that may appear similar to each other:
- Actinic granuloma annulare
- Dermoid cyst
- Erythema nodosum
- Erythema annulare centrifugum
- Elastosis perforans serpiginosa
- Foreign body granuloma
- Insect bite
- Lichen planus
- Necrobiosis lipoidica diabeticorum
- Perforating granuloma annulare
- Perforating collagenosis
- Rheumatoid nodule
- Subcutaneous granuloma annulare
- Sarcoidosis
What to expect with Granuloma Annulare
Granuloma annulare is a harmless condition that typically goes away on its own. Without any treatment, the skin abnormalities or ‘lesions’ often disappear naturally, normally over a period of several months to years. There isn’t a proven effective treatment for this condition, but since these lesions typically don’t cause any problems, it is generally acceptable to just monitor the condition and wait for it to improve on its own.
For many people, this condition completely goes away within a few years. However, it may stick around longer when it spreads to other parts of the body (a form that doctors call ‘generalized’), compared to when it is just found in one single location (a form known as ‘localized’).
Possible Complications When Diagnosed with Granuloma Annulare
Granuloma annulare is a harmless condition that often resolves on its own.
Preventing Granuloma Annulare
It’s important to understand that there’s not much a person can do to control the progress of a skin condition called granuloma annulare. So far, there’s no scientific proof that your diet can impact this condition. If the appearance of the affected skin areas bothers you, using skin camouflage methods could be a useful way to hide them.
