Granuloma Annulare (GA) is a relatively uncommon skin condition, characterized by red/skin colored circular asymptomatic Rash with elevated borders and central depression, closely resembling ring worm.
WHO CAN DEVELOP (EPIDEMIOLOGY)
As mentioned earlier, it is a relatively uncommon skin condition/disease.
It is seen more commonly in children and in females.
Incidence after the age of 30 is rare.
It can be associated with Diabetes and thyroid problems.
CLINICAL FEATURES & SYMPTOMS
Cinical features of Granuloma Annulare (GA) includes :-
- Characteristic asymptomatic ring-rashes that are slightly elevated in the periphery and depressed in the middle.
- It can closely resemble ‘daad’ or ringworm infection.
GA rashes are mostly asymptomatic. Pain and itching is rarely seen in this condition. However, cosmetic problems and appearance of the skin is the major cause of treatment.
- Localized GA – it appears in isolated areas of the body, mostly seen in the dorsum of Hand and foot.
- Generalized GA – It is characterized by multiple small rashes all over the body, which may combine to turn larger rashes. It appears more on the sun exposed part of the body.
- Diagnosis of GA can be done by simple clinical examination by any professional dermatologist.
- In a variant called papular Granuloma Annulare, the rashes appear different from the classical form. In such cases, Skin biopsy is done to confirm the diagnosis.
- GA is usually asymptomatic. So rarely, if a patient complains of pain and itching, KOH test is done to rule out fungal infection (ringworm)
In KOH test, the skin is gently scraped on the surface and a sample of the skin is collected and sent to the laboratory, to detect the presence of fungi.
GA is normally self-limitingand resolves within 1-2 years.
However, various methods for prompt treatment are also available :-
- Steroid creams – High potency steroid creams like Clobetasol, Halobetasol, Mometasone.
- Intra lesions Steroid injection for rapid resolution.
- Oral medications – Dapsone, Isotretinoin, Hydroxy chloroquine, Niacinamide etc.
- In resistant cases (rashes do not go away easily, even on treatment), biological medications, such as Infliximab, Etanercept, Adalimumab can be used. However, these are very costly.
Granuloma Annulare is a chronic disease, and recurrence is common on old sites, even after resolution/treatment of previous rashes. However, the recurrent cases are easily curable and is not cause for much concern.