A chronic skin disease characterized by the appearance of towering dense knots, forming a ring with a slightly imprinting or normal skin in the center, called the annular granuloma.
Disease in most cases are asymptomatic and do not require special treatment, however, to accelerate the healing of nodules physician may prescribe corticosteroid cream or subcutaneous administration of corticosteroids. According to statistics, granuloma annulare occurs in 0, 4% of patients with dermatological diseases.
The cause of granuloma is still unknown, but assumed the pathology of the immune system, against which developing delayed-type hypersensitivity, and disturbed cellular immunity. Contributing to the annular granuloma factors are:
- Sarcoidosis and tuberculosis;
- Carrying out tuberculin tests;
- Genetic predisposition;
- Hashimoto's thyroiditis;
- Rheumatism and vasculitis;
- Long-term use of vitamin D;
- Injuries of the skin, sunburn and insect bites;
There are the following forms of annular granuloma:
In medical practice, often there are cases when the annular granuloma developed on the site of scars and tattoos, after the shingles and warts.
The symptoms of granuloma annular
The main symptom is the appearance of annular granuloma on the patient's skin nodules of yellowish color or hue of the skin surrounding the affected area. These nodules can form one or more rings, often appear on the feet, hands, arms and legs of adults and children. Granuloma annulare usually does not cause pain or itching at the site of occurrence.
Annular granuloma in children
The most common among children is a localized form of granuloma, it is found in 90% of cases. On extensor surfaces of hands, arms, feet and legs, sometimes in the periorbital area, there is one or more foci with dense dermal papules. Color formation is typically coincides with the surrounding skin tone or slightly reddish papules arranged in an arc shape or a ring size of 2-5 cm and a central portion of the hearth and epidermis usually remain unaffected.
Distributed local granuloma annulare in children on the periphery, partly recurring or allow the same place. In medical practice, reported cases where children appear rings nested one within the other, resembling exudative erythema multiforme.
The subcutaneous form of annular granuloma is found only in children younger than 6 years old, it has the form of single or multiple deep, clinically unexpressed, dermal or subcutaneous nodules on the elbows, periorbital area, arms, legs, fingers, back of the hands and on the scalp. A feature of this type of granuloma is that nodes formed on the scalp, in all cases, are firmly connected to the periosteum, while mobile units on the limbs, and only in rare cases, connected with the fascia.
Disseminated granuloma annulare in children is extremely rare, it affects mainly adults aged 50 years and older. Manifestations of the disease are common throughout the body, and often on the distal parts of the limbs and trunk, papules purple hue or color. Tendency to have such annular skin lesions is not, there is polymorphism rash.
Perforating granuloma annulare occurs mostly in children and adults under the age of 30 years. In the hands or fingers of patients with papules appear on the center caps that release gelatinous contents, and then formed pockets and cover with umbilicated in the center. These structures evolve over time into large plaques with atrophic hyper- or hypopigmented scars.
Diagnosis of annular granuloma
When nodules patient should seek help from a dermatologist or a dermatologist, which is the clinical picture can make an accurate diagnosis. Only in the most cases of doubt, the patient may take a sample of the skin in the affected site granuloma.
Treatment of granuloma annular
The disease usually requires no special treatment and resolves itself. For faster healing of skin doctor may prescribe a cream, which include corticosteroids, or intradermal injection of corticosteroids. It is important after applying ointment to the skin from top to apply an occlusive dressing.
Funds must be used daily for two weeks, then for 2-3 weeks, apply once every two days.
Also, treatment of granuloma annular surface can be performed by scarification, sometimes leading to the resolution of the hearth biopsy.
Phototherapy, PUVA therapy, ultraviolet irradiation, the use of retinoids and anti-malarial drugs are included in the list of possible systemic effects at the granuloma, but none of them is safe and effective therapy is not recommended for children.
Clinically confirmed that cryotherapy, which is used for the treatment of granuloma annular in cosmetology, leading to disease progression and proliferation of the centers on the periphery.
For the treatment of localized form of granuloma annulare in children is a safe means of corticosteroid ointment Psoriderm fourth generation, which confirms the effectiveness of clinical trials. Because the tool is used in small doses and applied to the local area of skin, the likelihood of side effects is very low, with those cases have been recorded.
Granuloma annulare is a benign cutaneous nodule formation forming a ring that does not cause pain or itching. Usually education go away after a while, but if the patient is not typical symptoms of granuloma, it is necessary to consult a dermatologist.