Granuloma Annulare Rashes

Granuloma annulare is a chronic skin rash most often seen in children and young adults. It usually affects people with no previous medical problems and is seen more often in females. The rashes appear most commonly on the hands, feet, elbows and knees. The rashes themselves aren't dangerous, but they can have a negative impact on cosmetic appearance.

Causes

• Granuloma annulare in children is strongly associated with juvenile diabetes mellitus. Occasionally, these rashes are also associated with thyroid disease or dysfunction. Generalized granuloma annulare, the severe form of the rash, has developed in patients with undiagnosed chronic myelomonocytic leukemia. Most cases of granuloma annulare rashes, however, occur in healthy individuals. In these cases, the cause is unknown.

Symptoms

• The two most common symptoms of granuloma annulare rashes are mild to moderate itching and a circular formation of small red papules. The lesions often go away for a period of time, only to reappear later. The rashes appear most often on the hands and feet. The severe form of granuloma annulare is characterized by smaller lesions covering most or all of the body. Itching is more common and more intense in severe cases.

Tests and Diagnosis

• Granuloma annulare rashes are often misdiagnosed as ringworm due to similarities in appearance. A KOH test can be done to help rule out fungal infections like ringworm. In a KOH test, skin cells from the rash are scraped, mixed with potassium hydroxide and are examined under a microscope. If the skin scraping is negative for fungal infections, a skin biopsy may be performed. A small piece of skin from the rash site is removed and viewed under a microscope. A skin biopsy will confirm granuloma annulare.

Treatment

• In people with a localized rash, topical steroids are the first line of treatment. If the lesion is thick, the cream or ointment may be covered with a bandage to enhance efficacy. Steroids can also be given by injection into the rash if the lesions are very thick or don't respond to topical steroid treatment. Some physicians opt to freeze the rashes with liquid nitrogen, especially if there is only one lesion or if the lesions are relatively small. The liquid nitrogen helps to remove the lesions and promote new cell growth. If the rash is spread throughout the body, patients will often undergo ultraviolet-light therapy or laser therapy. Very rarely, lesions are removed with surgery.