Last reviewed by Editorial Team on August 13th, 2018.
What is Granuloma Annulare?
This is a chronic benign skin rash which means that it is not cancerous. This is a skin rash that usually affects females who are younger than fifteen years of age. It occurs mostly on the back of your feet and hands but can occur on your knees and elbows too. It is characterized by the ring shaped localized nodular inflammation that occurs on the middle layer of your skin known as your dermis. There are many different types that are classified based on their distribution on your skin and the symptoms, or characteristics they show.
Three types of granuloma annulare are:
- Localized – this type will occur on your elbows, hands, knees, and feet and is the most common type.
- Generalized – with this type the lesions spread over your entire body and is a severe case. It occurs mostly in adults. As many as fifteen percent have it all a large portion of their bodies.
- Subcutaneous – with this type you will see nodules that are located below your skin epidermis that are pinkish in color and there is no significant alteration of your overlying skin. This type occurs primarily in young children.
Usually when a person has granuloma annulare there are no symptoms and they will go unnoticed but they do have some general characteristics. Each type has their own symptoms and size of the bump.
- The skin is either a reddish color or the color of your skin and appears to be a rash at first
- The marks on your skin resemble insect bites
- The bumps are smooth, round and small and progress to lesions
- There are raised lesions or bumps that can link together to form patterns of a ring that looks like a ringworm infection. Inside the ring the skin is clear.
- The bumps are typically less than a half inch in diameter.
- Mild itching but not in all people
Localized granuloma annulare symptoms
- Lesion borders have a semicircular or circular shape
- Lesion diameter can be up to two inches
Generalized granuloma annulare symptoms
- Lesions are smaller
Subcutaneous granuloma annulare symptoms
- It produces a firm bump instead of a rash under your skin
- The bump is usually less than one point five inches in diameter
The exact cause of granuloma annulare is not known but there are some things that seem to be the trigger for a person to have this benign skin condition. Most people who have granuloma annulare are in good health. Some of the triggers can include:
- Insect or animal bites
- Tuberculin skin tests
- Exposure to the sun
- Infections, including hepatitis
- Hormonal imbalances
- Childhood diabetes
- Being under a lot of stress
- Immune reactions that are caused by the side effects of some medication
If you are over the age of forty or have a disease of the thyroid or diabetes mellitus you are at a greater risk of having generalized granuloma annulare.
When you visit your physician because of having a rash or bumps under your skin they can just examine the skin that is affected and diagnose granuloma annulare but to confirm it your physician may do a skin biopsy so they can examine it under the microscope to rule out any other skin diseases. The physician can also do a KOH test which is where they will scrape the skin to gather some dead skin cells. They will mix the dead skin cells with potassium hydroxide and examine it under the microscope. This test helps the physician to determine if the infection is caused by some type of fungus. The physician may also have a blood test done to check to see if there are any other possible diseases causing these rash/lesions.
This skin infection poses no health problems so there is no need to treat it but many people opt for treatment because granuloma annulare is unsightly. They do it for cosmetic reasons. The skin lesions will usually go away on their own within a couple of years. Some of the ways it can be treated include:
- Using corticosteroids, which is an anti-inflammatory medication, to help cure the swelling and reddening of the part of your skin that is affected. This is usually the first treatment that is used. The reason is that the inflammation that is caused by granuloma annulare has to be decreased in order to improve the appearance and condition of your skin lesions. When the symptoms are minor and the skin lesion is thin the physician will either prescribe an application of topical corticosteroid or tell you to use one of the over-the-counter ones. After putting on the topical corticosteroid you need to cover it to enhance the potency of it. If the symptoms are major and your affected skin is thicker the physician will usually inject corticosteroids directly into your skin that is covered with the lesion(s).
- The next method is to use cryotherapy which is where they will apply liquid nitrogen on the part of your skin where the lesion is in order to freeze the lesion to make excision easier.
- The next method is to use an oral product that is based on retinoids. These are vitamin A derivatives. One of the medications that is used is Accutane. Retinoids are used to act as an immunomodulator along with inhibiting the growth of cells.
- The next method is to use phototherapy which combines a medication called psoralens with ultraviolet light. This combination will make your affected skin accept the ultraviolet rays better. This is the method that is only used in granuloma annulare cases that are serious.
- Rub some mayonnaise on your affected skin. Leave on for twenty minutes, and then use cold water to wash the mayonnaise off. You should do this for fifteen days, twice a day. This treatment will improve the condition of your skin where the bump/lesion is.
- Rub vinegar to the affected skin and leave on for ten minutes. Rinse off with cold water. Do it one time a day for thirty days to get good results.
- Change your diet by avoiding fatty foods, sweets and eating more foods, especially fruits and vegetables that are rich in vitamins, minerals, and fiber.