What is Granuloma Annulare?

Granuloma annulare is a common skin rash. Affecting between 0.1% to 0.4% of people, this benign skin condition appears as a raised, discolored ring. While the rash is not particularly harmful, it can last for up to two years before disappearing. For this reason, many people with this condition seek medical treatment to help resolve symptoms. Also known as necrobiotic papulosis, granuloma annulare is more common in young people than in adults, but it can affect people of all ages.

People who suspect they have granuloma annulare should visit a dermatologist. While the condition itself is not dangerous, living with a long-term rash can be difficult. Localized and systemic therapy can help ease symptoms and improve a patient’s quality of life. Additionally, granuloma annulare symptoms overlap with those of more serious conditions, like Lyme disease. Visiting a doctor at the onset of a strange rash is the best way to receive appropriate treatment.

Symptoms of Granuloma Annulare

Granuloma annulare can present differently depending on a person’s genetics, general health, and environment. But, while there are several types of granuloma annulare, certain symptoms are common across variations:

• Rough, ring-shaped bumps on the skin
• Red, brown, yellow, and/or skin-colored lesions
• Patients generally observe a ring of small, firm bumps (papules) above the backs of the forearms, hands or feet.
• Ringed red bumps on soles of feet.
• Mild itching in some people, though the lesions generally cause no pain or itching.
• Yellowish or skin-colored bumps.
• Ringed red bumps on the back of the hands.
• Multiple rings may be found.
• Ringed red bumps on elbows.
• A skin biopsy may also be essential to confirm the diagnosis of granuloma annulare.

The rash itself typically has a sunken center and raised bumps that form the ring. Granuloma annulare rarely causes pain or itching, but certain types of the condition can be sensitive to the touch. Lesions can be localized, or they can spread across the body. The American Academy of Dermatology Associate provides detailed photographs for patient reference.

If you suspect that you have granuloma annulare, see a dermatologist. This condition is not often dangerous, but its symptoms overlap with serious conditions. This includes pityriasis rosea, psoriasis, nummular eczema, and Lyme disease. Only receiving a diagnosis from a medical professional can rule out these other conditions. Additionally, seeing a doctor can provide treatment to help minimize symptoms, improving a patient’s quality of life.

Causes of Granuloma Annulare

Healthcare providers and medical researchers don’t know the exact cause of granuloma annulare. Some research suggests that your immune system might have an inappropriate response to an injury to your skin.

Healthcare providers and medical researchers also think the following may trigger granuloma annulare:

• Insect bites.
• Certain medications, like allopurinol
• Some diseases, like human immunodeficiency virus (HIV) and hepatitis C.

Some people develop granuloma annulare after exposure to environmental triggers, like being out in the sun for a long time.

How is Granuloma Annulare Diagnosed?

When you see a doctor for a granuloma annulare diagnosis, they will perform a routine physical exam. Most doctors will also ask standard health history questions. To confirm a diagnosis, a doctor may run a test. Common granuloma annulare diagnostic tests include:

Skin biopsy: In this noninvasive procedure, the doctor will cut out a small piece of skin. They will then examine the sample for signs of other conditions that may be causing the rash.

Skin scrape: In this test, the doctor will use a tool to scrape off the top layer of skin. They will then examine the sample under a microscope to determine whether the rash is a result of a fungal or bacterial infection.
In both tests, the patient may wait several days for a result. If a doctor cannot provide a definitive diagnosis after these tests, they may suggest a blood panel to explore other potential causes.

Outlook / Prognosis of Granuloma Annulare

For most people, granuloma annulare clears up on its own without treatment, and it doesn’t leave any scars or traces behind.

However, granuloma annulare is a chronic disease. Lesions often return, and rashes often return in the same place. If your lesions or rashes come back, they usually disappear faster than when they first appeared.

Can a Change in Diet Get Rid of Granuloma Annulare?

Changes to your diet may help improve granuloma annulare. Some studies suggest that restricting the amount of lipids (cholesterol and triglycerides) in your diet may cause granuloma annulare to disappear faster. This may also be true if you have diabetes, elevated lipids in your blood or other conditions that healthcare providers sometimes see in people with granuloma annulare.

Is Granuloma Annulare Caused by Stress?

Some research suggests that chronic stress may cause granuloma annulare. Reducing your stress may help prevent granuloma annulare. Try the following tips to help reduce your stress:

• Count to 10 as you take a deep breath.
• Exercise daily.
• Drink caffeine and alcohol in moderation.
• Sleep eight hours a night.
• Eat healthy foods.
• Try to have a positive attitude.
• Journal every day.
• Talk about your life with friends, family and a therapist

Reference:

https://my.clevelandclinic.org/health/diseases/17874-granuloma-annulare

https://www.premiermedicalhv.com/divisions/services/granuloma-annulare/