Granuloma Annulare

Granuloma Annulare – A Benign & Fairly Common Skin Rash

Granuloma annulare is a benign and a fairly common long lasting skin rash which seems like a ring of small red bumps, more common in females which usually occur over the back of the forearms, hands or the feet, the cause of which is not known.

This condition tends to occur in healthy individuals and occasionally could be associated with people suffering from diabetes or thyroid disease. It has also been connected with auto-immune diseases like systemic lupus erythematosus, rheumatoid arthritis as well as Addison’s disease. It is a self-limited popular eruption which is found among individuals of any ages where the primary skin lesion tends to group papules in an enlarging annular shape and its colour ranges from flesh colour to erythematous.

The rash is the only symptom in the case of granuloma annulare with no other health effects. The rash tends to be slightly itchy and there could be a number of rings on the back of the forearms, hands or feet, mostly centred on the joints or the knuckles, which may grow slowly till they are around 2.5 – 5cm across and become flatter and more purples till they eventually tend to disappear. The bumps are due to the clustering of T cells beneath the skin and the papules begin as very small pimple like a bump that spread over a period of time and grows gradually.

Localized/Disseminated

In rare cases, the rash may spread to other areas of the body or there could be one or more lumps under the skin of the arms or legs, which is known as subcutaneous granuloma annulare. Though it may disappear without any treatment within a period of one or two years, it could at times last for many years with new rings showing up. Granuloma annulare is not an infectious disease nor caused by allergies.

The two most common forms of this disease are localized which is found on the lateral or the dorsal areas of the feet and hands and disseminated that is widespread. The localized disease is self-limited and tends to resolve in a span of one to two years while disseminated disease tends to last longer. The localized granuloma annulare being self-limited, no treatment may be needed other than reassurance.

Treatment Based on Patho-Physiology/Case Report/Opinion of Experts

Treatment is based on patho-physiology of the ailment, case reports and the opinion of the experts and for localized disease, liquid nitrogen, injected steroids or topical steroids under occlusion could be recommended. In the case of disseminated granuloma annulare, it could be treated with one of the various systemic therapies together with ultraviolet-A therapy.

People suffering from this condition tend to face discomfit since the papules appear like ringworm which is a slightly contagious itching skin disease taking place in circular small patches together with scaling which is unlike granuloma annulare caused by various fungi. This disease in some cases could draw the attention of others towards these patches causing much discomfit to the victim. In such cases, regardless to the prevailing atmosphere, they are bound to wear attire which may be needed to cover these areas and save them from unwanted glances from the others around them.