Granuloma annulare

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Granuloma annulare
Perforating form of granuloma annulare on hand
SpecialtyDermatology Edit this on Wikidata

Granuloma annulare (GA) is a common, sometimes chronic skin condition which presents as reddish bumps on the skin arranged in a circle or ring.[1] It can initially occur at any age, though two-thirds of patients are under 30 years old, and it is seen most often in children and young adults. Females are two times as likely to have it as males.[2]

Signs and symptoms

Micrograph showing a palisaded granuloma in a case of granuloma annulare. H&E stain.

Aside from the visible rash, granuloma annulare is usually asymptomatic. Sometimes the rash may burn or itch. People with GA usually notice a ring of small, firm bumps (papules) over the backs of the forearms, hands or feet, often centered on joints or knuckles. The bumps are caused by the clustering of T cells below the skin. These papules start as very small, pimple looking bumps, which spread over time from that size to dime, quarter, half-dollar size and beyond. Occasionally, multiple rings may join into one. Rarely, GA may appear as a firm nodule under the skin of the arms or legs. It also occurs on the sides and circumferential at the waist and without therapy can continue to be present for many years. Outbreaks continue to develop at the edges of the aging rings.[citation needed]

Causes

The condition is usually seen in otherwise healthy people. Occasionally, it may be associated with

systemic lupus erythematosus, rheumatoid arthritis, Lyme disease and Addison's disease. At this time, no conclusive connection has been made between patients.[citation needed
]

Pathology

Granuloma annulare microscopically consists of

dermal epithelioid histiocytes around a central zone of mucin—a so-called palisaded granuloma.[3]

Pathogenesis

Granuloma annulare is an idiopathic condition, though many catalysts have been proposed. Among these is

The mechanisms proposed at a molecular level vary even more. In 1977, Dahl et al. proposed that since the lesions of GA often display a thickening of, occlusion of, or other trauma to

immune-mediated, type 3 reaction or that chronic immune vasculitis may be involved in the pathogenesis.[6][7] Another study found evidence suggesting blood vessel involvement with masses of intercellular fibrin and thickened basal lamina found around capillaries.[6][8]

Umbert et al. (1976), proposed an alternative pathogenesis: cell-mediated immunity. Their data suggests that

delayed-type hypersensitivity with resulting tissue and vessel changes rather than an immune-complex mediated disease.[10] Further data has been collected supporting this finding.[6][11][12]

Diagnosis

Types

Granuloma annulare may be divided into the following types:[13]: 703–5 

Treatment

Because granuloma annulare is usually asymptomatic and self-limiting with a course of about two years, initial treatment is generally

corticosteroids.[14][15] Treatment success varies widely, with most patients finding only brief success with the above-mentioned treatments. Most lesions of granuloma annulare disappear in pre-pubertal patients with no treatment within two years while older patients (50+) have rings for upwards of 20 years. The appearance of new rings years later is not uncommon.[16]

History

The disease was first described in 1895 by Thomas Colcott Fox as a "ringed eruption of the fingers",[2] and it was named granuloma annulare by Henry Radcliffe Crocker in 1902.[17]

See also

References

  1. ISBN 978-0729540759; pbk{{cite book}}: CS1 maint: postscript (link
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  2. ^
    OCLC 1011508489.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link
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  14. ^ "Granuloma Annulare Treatment". www.buzzle.com. Archived from the original on 2010-01-25.
  15. ^ "Granuloma annulare | DermNet NZ".
  16. ^ Ghadially, Ruby (15 October 2020). "Granuloma Annulare: Treatment & Management". Medscape. Retrieved 19 August 2023.
  17. PMID 20061743, retrieved 23 May 2010{{citation}}: CS1 maint: numeric names: authors list (link
    )

External links