What causes Granuloma annulare to become active? I had one spot on my elbow for about 13 years, no one could tell me what it was. I went through creams, tape, had it frozen, had it burned off nothing got rid of it. I went to a Dermatologist she looked at it and told me what it was did a biopsy to be sure. I then had steroid injections and after 3 treatments it went away. I now have patches all over my lower legs. Again the Dermatologist that my insurance had referred me to will only treat it with cream. What else can I do?
Generalized granuloma annulare GGA is an uncommon variant of granuloma annulare GA, representing 8% to 15% of all cases of GA. It is defined as affecting at least the trunk and either the upper, lower, or both, extremities . GGA most frequently occurs in middle-aged to elderly adults, between 30 and 60 years old. However, in 20% of the cases it occurs before the age of 10 years and rare cases of GGA in infants have been reported. The clinical morphologic patterns of GGA can be divided into the annular and non-annular patterns. Among them, the non-annular pattern is composed of symmetrically scattered papules often coalescing papules. It is different from the annular pattern by a nearly equal female-to-male ratio, certain labora tory abnormalities such as a lower incidence of elevated serum lipids and a more frequent occur rence of increased titers of gamma globulins and immunoglobulins. The non-annular pattern also shows positive staining for lipid more frequently. In our two cases, erythematous papules were diffusely scattered on the trunk, upper and lower extremities and they are compatible with non-annular GGA.Typical histopathologic findings of GGA are ne- crobiotic collagen and mucin in the dermis with sur rounding inflammatory cells of histiocytes, multi nucleated giant cells, and a few acute inflammatory cells. Although histopathologic differences between localized GA and GGA are minimal, collagen sclerosis, palisading pattern and decreased or absent elastic fiber in granulomatous inflammation foci occurred more commonly in localized GA than in GGA . In our two cases, collagen sclerosis and palisading pattern are not prominent on the histopathology.GGA is a chronic disease with a relapsing course and shows a poor therapeutic response. These circumstances have led to numerous treatments, including systemic corticosteroid, isotretinoin, PUVA, potassium iodide, sulfone, hydroxychlo roquine, niacinamide, topical vitamin E, topical corticosteroid, and cryotherapy. However, in our two cases, the lesions disappeared leaving hyperpig- mentation after treatment with topical or systemic corticosteroid for a month. No recurrence was observed during the follow up period of 15 months and 4 months, respectively.
DEAR DR. DONOHUE: My 53-year-old daughter has granuloma annulare all over her body in varying sizes. Her job entails contact with the general public, who eye her warily, thinking she might be contagious. Is there anything that could cover this up? — B.H.
ANSWER: Granuloma annulare consists of firm, red, round skin patches. The central part of the patch pales, so the patch looks like a red ring. It can be limited to a few skin areas, or it can be generalized, like your daughter’s outbreak. Protopic ointment sometimes can cause fading. So can treatment with ultraviolet A light, along with oral drugs called psoralens. Usually, both the limited and generalized forms leave on their own.
However, camouflaging the patch is a great idea. The best help is at the cosmetics section of a department store, where a variety of materials can be tested.
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).
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).
What is Granuloma Annulare
What is granuloma annulare? The term is used to describe a long-term mild inflammatory skin disease that should not be mistaken for warts though they look similar. Some characteristics of the disease are:
- It is usually asymptomatic.
- The rash is symmetrical.
- It forms a ring of small firm bumps.
- It covers the backs of the forearms, hands or feet, and around the knuckles and joints.
- It affects children, young, and older adults.
- It has been observed that it is found more in females.
- In some cases, the rash may burn and feel itchy.
- Sometimes multiple rings may be found in one area.
In children, it doesn’t need treatment because it disappears within 2 years.
In older people, those 50 or above, the granuloma annulare can stay up to 20 years, since new rings are formed now and then.
Causes of Granuloma Annulare
- Granuloma annulare.
- Pyogenic granuloma.
- Diabetes mellitus.
- Herpes zoster lesions
Symptoms of of Granuloma Annulare
- Reddish or skin-colored bumps lesions.
- Mild itching.
- Nodule under the skin of the arms or legs.
Treatment of Granuloma AnnulareTroublesome patches may improve using steroid creams or ointments, or occasionally steroid injections into the rings. Sometimes it is helpful to apply a strong steroid preparation to the skin or steroids can be injected into the bumps themselves. Small plaques can be frozen cryotherapy. Topical imiquimod and topical
Granuloma annulare (GA) is a relatively infrequent condition affecting the dermis or the subcutaneous tissues. The aetiology of GA is purely speculative, but links with other diseases have been reported since the condition was first described. This paper discusses the usual presentation of GA, typical sites of involvement, and reviews the histology of the subcutaneous lesions of GA. It also reports a case of a 31-year-old patient who presented to an oral surgeon with subcutaneous lesions in the right supra-orbital region. A comparison between this lesion and another histologically similar entity is drawn. The reasoning behind the eventual definitive diagnosis is explained, and a review of the literature found GA affecting the head and neck to be rare.
Granuloma annulare is a granulomatous disorder, which is more common in females. The age of onset is usually less than 30 years. Several precipitating factors have been proposed, which include sun exposure, insect bites, viral infections, thyroiditis, tuberculin skin tests and trauma.  Granuloma annulare (GA) has varying clinical presentations that include localized, generalized, subcutaneous, and perforating forms. A generalized form of granuloma annulare can occur in up to 15% of patients, and is characterized by multiple, asymptomatic, erythematous or skin-colored plaques located primarily on neck, trunk and extensor surfaces of extremities.  Generalized granuloma annulare is characterized by a later onset, poorer response to therapy and an increased prevalence of the HLA-Bw35 allele.  Alterations in the lipid profile (hypercholesterolemia, hypertriglyceridemia, or both) were found to occur in 45% of patients with generalized granuloma annulare.  Generalized granuloma annulare may represent a paraneoplastic phenomenon in patients with lymphoma or other malignant conditions.
Etiology of childhood granuloma annulare is unknown.
No good evidence supports suggestions that trauma, tuberculosis, streptococcal infection, herpes zoster/varicella, collagen vascular disorder, or diabetes mellitus are causally related to granuloma annulare. There are also weak associations with BCG vaccination; drugs such as allopurinol and zalcitabine; other viral infections such as EBV, HIV, hepatitis C, Parvovirus B19; autoimmune thyroiditis; and malignant conditions. Borrelia has also recently been implicated in one study.1
There is some evidence to suggest that granuloma annulare is an immunologic disease in the form of delayed type hypersensitivity reaction.
The cause of pyogenic granuloma is unknown.
Suggested potential risk factors include pregnancy, birth control pills, bacterial and viral infections, microscopic arteriovenous anastomoses, and angiogenic growth factors, but no good evidence supports any of these as primary causative factors. In one large pediatric series, only 7% had any history of trauma preceding the development of the lesion.
Pyogenic granulomas have been reported arising within port wine stains. On rare occasions, lesions have been associated with malignancy.
Intraoral lesions can have an appearance and behavior very similar to the appearance and behavior of intraoral Kaposi sarcoma. These lesions may bleed extensively if biopsied; thus, HIV testing may be indicated when patients have intraoral lesions with the appearance of pyogenic granuloma.