Causes and risk factors
The exact cause is not yet known. It is an autoimmune disease where there is excessive production of white blood cells. It is caused due to delayed hypersensitivity reaction to a component of dermis and inflammation mediated by tumour necrosis factor alpha [TNF α]. Following are triggering factors for the development of Granuloma annulare- infections, bites of insects or animals, vaccination, sun exposure, tuberculin skin tests. It may be associated with disease like diabetes or thyroid disease. This disease occurs more commonly in children and young adults.
Clinical presentation
The symptoms will depend upon the type of presentation i.e. localised, generalised or subcutaneous. Localized is the most common type of granuloma annulare. It occurs most commonly on the back of hands, knuckles, top of feet, joints such as wrists and ankles. The borders of the lesion have a circular or semicircular shape, with a diameter up to 2 inches. Centre is little depressed. Generalized are the lesions present over a large portion of the body including the trunk, arms and legs. They are skin coloured, or mauve or pink coloured patches or papules arranges symmetrically. Itching may be present. Subcutaneous type of granuloma annulare produces a firm lump or nodules under the skin instead of a rash. It is seen in scalp margins, finger tips, and shin. The lump is usually less than 1.5 inches in diameter. It is rubbery in consistency. It is seen mostly in children.
Investigation
Medical history by the patient and Clinical examination by the dermatologist helps in diagnosis. It is recognised by its characteristic appearance. A skin biopsy is recommended
Treatment
No treatment is required for most patients since this disease is self-limiting. However, if the symptoms are very troublesome, treatment such as Corticosteroids in the form of ointments or injections may be advised. Cryotherapy i.e. liquid nitrogen is used to freeze the lesions. Ultraviolet light therapy is also useful in treating granuloma annulare. In cases of widespread presentation Oral medications to suppress the immune system may be required.
Other Modes of treatment
The other modes of treatment can also be effective in treating granuloma annular.
Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating granuloma annulare.
