OVERVIEW
Granuloma annulare is a rare benign inflammatory skin disease. It often occurs in children and young adults with type 1 diabetes mellitus. The lesions are most commonly found on the hands or feet, but sometimes spread to the arms, neck, and trunk. Normal skin color or erythematous papules and ring-shaped lesions 5 cm in diameter are common, without obvious itching. It is often treated by local or intra-lesional glucocorticosteroid injections, and in severe cases, it can be treated with amphotericin.
Etiology
The etiology of the disease is unknown, and patients often have a history of tuberculosis, diabetes mellitus, or insect bites, trauma, sun exposure, or family history.
Symptoms
Early presentation is with brightly colored red or reddish brown lumps. These lumps gradually fuse to form ring-shaped patches. The skin flattens in the middle of these rings, which can be red or bright red. There are no symptoms other than the appearance of the plaques. Usually, granuloma annulare lesions appear on the hands and feet, but if they spread to the trunk, they are called generalized granuloma annulare. Most granuloma annulare resolves on its own.
Tests
1. Laboratory tests
In adult patients with disseminated granuloma annulare, the erythrocyte sedimentation rate is accelerated, which can reach 40-50mm/h, and there can be antithyroid antibodies in the blood; eosinophils in the peripheral blood of patients with insect bites can be up to 6%-10%.
2. Histopathologic examination
The epidermis has no significant changes, and there are focal collagen fiber degeneration, inflammatory reaction and fibrosis in the reticular layer of dermis. Small foci can be seen in different degrees of degeneration of collagen fibers, with lymphocytes, histiocytes, fibroblasts infiltration. Large focal areas are centered on degeneration of collagen fibers, surrounded by fenestrated or radially arranged infiltration of histiocytes, lymphocytes, fibroblasts, and so on.
Diagnosis
Diagnosis is made on the basis of medical history, family history, clinical manifestations and histopathologic findings.
Treatment
1. Treatment of primary disease
The patient has a history of tuberculosis, diabetes mellitus, or insect bites, trauma, or sun exposure. To remove the primary disease, for example, diabetes can be treated by local or intra-lesional injection of glucocorticoids, and severe cases can be treated with ampicillin.
2. Other
These include liquid nitrogen cryosurgery, light energy therapy, hydroxychloroquine, tacrolimus, pimecrolimus, and imiquimod.
Prognosis
The disease passes slowly and may subside on its own, recur, or persist for a long time.
Questions you may have
Can granuloma annulare heal on its own?
Cyclic granulomas with mild lesions can heal on their own, but patients with moderate to severe cases of cyclic granulomas will still need to be treated with medication and surgery.
Granuloma annulare is a group of skin diseases characterized by a ring of raised lesions formed by the fusion of small nodules and papules. It is more common in children and adolescents, and is two to three times more common in women than in men.
Generally speaking, ring granuloma can subside on its own without treatment if the lesions are mild and the symptoms are not serious. For patients with moderate or severe symptoms, minimally invasive surgery, laser therapy, cryotherapy, and local injections are often used to achieve early cure.
It is recommended that after diagnosis of granuloma annulare, the patient should take the most appropriate treatment according to the specific condition as soon as possible, so as to avoid delaying the condition.
Prevention
Avoid some controllable factors, such as tuberculosis, history of diabetes mellitus, insect bites, trauma, sun exposure, and if already suffering from tuberculosis or diabetes mellitus, it should be actively treated.
Care
Avoid external factors to stimulate the skin, eat a light diet, avoid spicy and irritating food, so as not to delay the healing of the disease.