Annular Granuloma

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Annular granuloma

Granuloma annularis is a complex disease, the etiology of which is not yet fully understood. It is believed that infections affect the development of this pathology. These include tuberculosis and rheumatism, diabetes (endocrinopathy), allergies, taking a certain group of drugs. A granuloma is a chronic benign condition in which papules and nodules form that form rings around small areas of skin.

According to some experts, annular granuloma refers to skin diseases resulting from a violation of carbohydrate metabolism. A granuloma is called an erythomatous skin lesion. With this disease, the skin becomes reddish, sometimes the color of normal skin or a yellowish-bluish tint. The rash usually occurs on the feet, legs, hands, and fingers.

There are no symptoms.

Often the disease develops after sunburn, insect bites. Usually not accompanied by ulceration. In adults, more often in women, single annular foci are found in the subcutaneous tissue of the forehead. The annular granuloma is characterized by small foci of collagen fibers with a disturbed structure, around which there is a slight infiltration.

The pathology cannot be detected immediately; the diagnosis is made due to the presence of histiocytes among collagen bundles. Granuloma formation occurs when activated macrophage cells take up, destroying or isolating the invading agent. The cause of this phenomenon is infectious agents such as lastomycosis, fungi, candidiasis, cryptococcosis, chromomycosis, coccidioidomycosis, histoplasmosis, sporotrichosis.

Types of annular granulomas

An annular granuloma is divided into two forms:

1. The typical form of this disease affects the skin of the feet, hands, knees, namely, their back. Not so often, but still, papules appear on the gluteal region, on the neck and in the forearm area. In elderly people and in diabetics, rashes can be localized on the lower and upper extremities, on the trunk.

2. The atypical form is divided into subcutaneous, disseminated and perforating granulomas.

With subcutaneous granuloma, there are many nodes on the upper limbs in the elbows, forearms, on the back of the hands, on the fingers, and rarely on the scalp and upper eyelid. The subcutaneous form of granuloma is similar to rheumatic nodules, develops exclusively in childhood, more often in girls.

In the case of the disseminated form, it is detected, as a rule, in adults and very rarely in children, the rash can spread throughout the body. The papules are purple or flesh-colored. Rashes are multiple, scattered. Due to their merging, a mesh is formed. The disseminated form is treated for a long time and is difficult.

· The perforating shape appears on fingers and hands after skin injuries. It is characterized by plugs in the center of the ring. A gelatin-like substance is periodically released from the nodules. When the lesions heal, the skin becomes crusted, a small dent forms in the center of the lesion, then scars appear. The papules of the perforating annular granuloma subsequently turn into large plaques.

The clinical manifestations of granuloma annulare are easily recognized. In most cases, the diagnosis is made accurately by visual examination by a dermatologist. Sometimes there is a need for a histological examination of biological material.

Treatment of single foci of annular granuloma is carried out using hydrocortisone ointment with ichthyol and phonophoresis. Therapy is used aimed at normalizing the immune system, inhibiting the formation of antibodies. The disease is associated with metabolic disorders, therefore, it is important to use corrective medications and simultaneously treat if, for example, there is tuberculosis, diabetes mellitus or one of the dangerous chronic infections.

Among the drugs, ascorbic acid, tocopherol acetate, B vitamins, and iron-containing products are prescribed. In many cases, a positive effect can be achieved by injecting papules with triamcenolone acetonide. The use of niacinamide, dapsone, hydroxychloroquine, isotretinoin is also useful. A substance called chloroethyl is used to irrigate the affected areas, which become covered with "frost" after application. You can also use carbonic acid or liquid nitrogen. Treatment is complemented by PUVA therapy, a method that includes the use of psoralens and irradiation of the skin with long-wave ultraviolet radiation. The outcome of the disease depends on the stage, the earlier the patient visits the doctor, the more positive the result will be.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".