Granuloma annulare

Overview

Granuloma annulare is a benign, often persistent skin condition characterized by inflammation that results in elevated, discolored rashes or subcutaneous lumps. When it persists for an extended period, it can cause emotional distress.

Rashes typically appear on the hands, feet, forearms, and elbows, and the condition most commonly affects young adults. Some medications and minor skin injuries may trigger it. The condition is non-contagious and usually painless, but it can significantly affect an individual’s self-esteem.

Without intervention, granuloma annulare can last from a few weeks to several decades. Treatment can help improve the skin’s appearance, but the raised bumps often return. Common treatments include medications and procedures.

Symptoms

Granuloma annulare can manifest in several types, each with its own set of signs and symptoms. The presentation may vary depending on the type:

• Localized: Localized granuloma annulare typically begins with small skin bumps that precede the appearance of a circular rash. These bumps can evolve into a rash with circular or semicircular patches, which may start out small and eventually merge. The rash can have various colors like red, pink, purple, or it may blend with the surrounding unaffected skin. This is the most common type and often affects areas like the hands, feet, wrists, and ankles.
• Generalized: Generalized granuloma annulare is characterized by the presence of bumps that develop over a larger area of the skin. These bumps tend to merge, forming larger discolored patches on the skin. It can affect most of the body, including the trunk, arms, and legs. It may also be accompanied by itching and discomfort. This type is rare and typically affects adults.
• Subcutaneous: This type is identified by the presence of small, painless lumps beneath the skin. These lumps can grow rapidly and usually have a firm, round, and discolored appearance, often in shades of red or pink. Common areas for the development of these lumps include the scalp, shins, and hands. Subcutaneous granuloma annulare is more frequently seen in young children.

If you experience any of these signs and symptoms and they persist, it’s important to consult a healthcare provider for a proper diagnosis and treatment. This is especially crucial when a persistent rash or a pattern of bumps resembling a ring-like shape appears on your skin.

Causes

The cause of granuloma annulare remains unknown to healthcare providers and medical researchers. However, there is evidence to suggest that it may be related to an inappropriate immune system response following skin injury. Additionally, certain factors are believed to potentially trigger granuloma annulare, including:

• Animal or insect bites.
• Specific medications, such as allopurinol.
• Certain medical conditions like human immunodeficiency virus (HIV) and hepatitis C.
• Tuberculin skin tests.
• Prolonged sun exposure.
• Vaccinations.
• Minor skin injuries.

In some cases, individuals may develop granuloma annulare after exposure to environmental factors, such as extended periods of sun exposure.

Risk factors

Granuloma annulare can affect people of any age, but it most frequently affects children and young adults. Other risk factors include:

• Gender: Women are more likely to get granuloma annulare than men.
• Certain diseases: Granuloma annulare may be more common in people with diabetes, especially Type 1 insulin-dependent diabetes, and thyroid disease, including thyroiditis, hypothyroidism, and thyroid adenoma.