Granuloma annulare in a 9-year-old child. Causes of granuloma annulare in a child. Disseminated granuloma annulare

Granuloma annulare is a benign skin disease, clinically manifested by ring-shaped papules, and pathomorphologically as granulomatous inflammation.

Etiology and epidemiology of granuloma annulare

The cause of the disease is unknown. The polyetiology of dermatosis is assumed, with a certain role assigned to chronic infection (tuberculosis, rheumatism, chronic infections of the respiratory system), sarcoidosis, endocrine disorders, diabetes mellitus (more often in the generalized form of the disease), long-term use of medications (vitamin D). Sometimes a connection with autoimmune thyroiditis is found. Trauma can play a provoking role in the occurrence of granuloma annulare. An association of granuloma annulare with tuberculin skin testing and BCG vaccination has been described. Viral infections (HIV, Epstein-Barr virus, herpes simplex virus and varicella zoster virus) can also contribute to the development of the disease. Granuloma annulare, associated with immunodeficiency (HIV infection, condition after liver transplantation), is more often generalized. The following mechanisms for the development of dermatosis are currently being considered:

Microangiopathies leading to degradation of connective tissue.
Primary degenerative process in connective tissue with a granulomatous response.
Lymphocyte-mediated immune response that activates macrophages.

The incidence of granuloma annulare is estimated at 0.1–0.4% of the total number of patients with dermatological pathologies.

Classification of granuloma annulare

There is no generally accepted classification.

Symptoms of granuloma annulare

Taking into account the clinical picture of the disease, the following forms of the disease are distinguished:

localized granuloma annulare;
deep (subcutaneous) granuloma annulare;
disseminated granuloma annulare;
perforating granuloma annulare.

Localized granuloma annulare is the most common form of the disease and is observed mainly in children (90% of cases) and young people. Localized granuloma annulare is characterized by the appearance of small (0.1–0.5 cm in diameter), dense, smooth hemispherical, slightly flattened shiny dermal nodules of a pinkish color or the color of normal skin, located in typical cases in a ring or in groups in the form of a semi-ring on the dorsum of the hands , feet, legs, forearms (60% - on the hands and arms, 20% - on the feet and legs). Lesions of the periorbital region and scalp are less common. The diameter of the lesions gradually increases, reaching 1–5 cm or more. In the central part of the lesion, the skin is normal or slightly bluish. The peripheral edge of the lesion consists of adjacent nodules. There are no subjective sensations. Lesions may partially resolve or recur at the same site. The epidermis is not affected. In the papular form, the nodules are located isolated from each other.

Deep granuloma annulare is characterized by subcutaneous nodules. It is observed almost exclusively in children under six years of age and manifests as single or multiple deep dermal or subcutaneous nodules on the legs, forearms, elbows, dorsum of the hands, fingers and scalp. The periorbital area, usually the upper eyelid, may also be affected. Nodules on the extremities are usually mobile, although they can be associated with the fascia; on the scalp they are always tightly connected to the periosteum. After surgical treatment, relapses may occur.

Deep annular granuloma.

Disseminated granuloma annulare is characterized by multiple foci of rash on different parts of the body. This form occurs in approximately 15% of patients with granuloma annulare, rarely in children. Most patients are over 50 years of age. Groups of papules, nodules, and skin-colored or violet-colored spots are observed throughout the body, but the distal extremities and trunk are most often affected. In these cases, the rashes are multiple, scattered or merging, which can give the lesions a reticular character, but without a significant tendency to a ring-shaped arrangement. Polymorphism of rashes is noted. A typical feature is symmetry. This form of the disease has a chronic, relapsing course, rarely resolves spontaneously, and is more resistant to therapy than the localized form.

Perforating granuloma annulare accounts for about 5% of all cases. Typically seen on the dorsum of the hands or fingers, but may simply be a traumatic variant of localized granuloma annulare. At least 50% of such patients are children or young people. The rashes are represented by papules that merge into large plaques and have a plug in the center, upon pressure on which gelatin-like contents are released; then crusts and lesions form with an umbilical depression in the center. Later, atrophic scars may develop.

Diagnosis of granuloma annulare

The diagnosis of granuloma annulare is based on the clinical picture, however, in some cases (suspicion of a disseminated and deep form of the disease), pathological examination of skin biopsies is necessary.
During pathomorphological examination, chronic infiltrates and granulomatous inflammation, foci of connective tissue necrobiosis, surrounded by a palisade of histiocytes, are observed in the upper and middle layers of the dermis; giant multinucleated cells. In the perforating form, foci of collagen degeneration are observed under the epidermis with the penetration of necrobiotic masses through the epidermis. In lesions that exist for a long time, numerous T-lymphocytes and fibroblasts may appear. The inflammatory infiltrate is represented mainly by activated Th1 lymphocytes. The tuberculoid reaction of giant cells is atypical. Sometimes degeneration of elastic fibers is observed in sun-exposed foci of granuloma annulare. Deposits of IgG and S3 around blood vessels in the dermis indicate the possibility of developing immune complex vasculitis.

According to indications, consultations with other specialists are prescribed: a therapist (required when prescribing physiotherapeutic treatment), an endocrinologist, an infectious disease specialist, an otorhinolaryngologist, a phthisiatrician.

Differential diagnosis

Differential diagnosis of granuloma annulare is carried out with necrobiosis lipoidica, which develops mainly in middle-aged people, who often have disorders of carbohydrate metabolism. With necrobiosis lipoidica, the rashes are localized mainly on the legs.

necrobiosis lipoidica

Small nodular sarcoidosis is characterized by bluish-brown rashes localized on the face. The disease most often occurs in adults. The phenomenon of dustiness during diascopy is characteristic. Typical foci of granuloma annulare are absent.

Rashes with lichen planus are characterized by polygonality, shine and a purple tint. Subjectively, patients are bothered by severe itching.

The disease is also differentiated from persistent raised erythema, the rashes in which are often localized around large joints. The nodules are more numerous, larger in size, acutely inflammatory in nature, denser in consistency, without a pronounced tendency to ring-shaped grouping. The rash is more persistent.

Rheumatoid nodules are often localized in the area of large joints, are larger, lie deeper, and are painful when pressed. Characterized by the presence of arthritis, changes in acute-phase blood parameters, and the presence of general symptoms (weakness, malaise, fever).

Treatment of granuloma annulare

Treatment Goals

regression of rashes;
no relapses.

General notes on therapy

When planning therapy, the tendency of granuloma annulare to spontaneous resolution should be taken into account. In approximately 75% of cases, the lesions spontaneously regress within 2 years. Although the recurrence rate is as high as 40%, new lesions may also disappear spontaneously.

If necessary, correction of carbohydrate metabolism and treatment of concomitant pathologies (foci of chronic infection, tuberculosis, diabetes mellitus) are carried out.

The drugs of choice for localized granuloma annulare are topical glucocorticosteroids. In case of disseminated skin lesions, systemic drugs or phototherapy are prescribed along with topical therapy.

Indications for hospitalization

None.

Treatment methods for granuloma annulare:

Drug therapy

External therapy

Glucocorticosteroid drugs:

hydrocortisone 17-butyrate, cream, ointment 0.1%
Alclomethasone dipropionate, cream, ointment 0.05%
betamethasone dipropionate, cream, ointment 0.025%, 0.05%
betamethasone valerate, cream, ointment 0.1%
methylprednisolone aceponate cream, ointment, emulsion 0.1%
mometasone furoate, cream, ointment, lotion 0.1%
clobetasol propionate, cream, ointment 0.05%

Systemic therapy

tocopheryl acetate: children aged 3 to 10 years - 50-100 mg per day orally, children over 10 years old - 100-200 mg per day orally, adults - 200-400 mg per day orally
vitamin E + retinol
ascorbic acid + rutin

Non-drug therapy

Cryotherapy once every 7–10 days, 3–5 procedures for each lesion. In this case, the entire surface of small lesions and the active edges of larger lesions (with a diameter of more than 4 cm) are treated. Transient side effects (pain, blistering and local swelling) and long-term complications (focal hypopigmentation and peripheral hyperpigmentation) are possible.

Special situations

Treatment of pregnant women with granuloma annulare:

There are no data on the treatment of granuloma annulare in pregnant women. If such clinical situations arise, local therapy methods are allowed to be used:

Topical application of tocopherol acetate (vitamin E)
Cryotherapy (D) once every 7–10 days, 3–5 procedures for each lesion.

Requirements for treatment results

Resolution of rashes.

Prevention of granuloma annulare

There are no methods of prevention.

IF YOU HAVE ANY QUESTIONS ABOUT THIS DISEASE, CONTACT DOCTOR DERMATOVENEROLOGIST KH.M. ADAEV:

WHATSAPP 8 989 933 87 34

EMAIL: [email protected]

INSTAGRAM @DERMATOLOG_95

Discussion: 16 comments

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Answer

The disease is quite rare. And the most important thing is that, as I understand it, the reasons for it are not known. Everything is described in quite detail and this is good, because timely detection of such a disease will help to cure it and stop it in time. There are so many diseases, but when something like this appears on the skin, it is noticeable and natural discomfort. We will now know what it is and what to do.

Answer

I had a similar granuloma, only in the chest, almost in the middle. It went away on its own after about 1.5-2 years. I didn’t go to the doctors because... There were no scary tumors, just a 3-4 mm abscess.

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Answer

Annular or anular granuloma is a slowly progressive dermatosis of unknown origin. This skin disease is characterized by the formation of ring-shaped lesions.

Granuloma annulare can form in people of any age, however, this dermatosis is more often observed in children and women. Lesions on the skin with this disease can exist naked, without causing much concern to the patient, and then suddenly disappear.

Causes

To date, it has not been possible to identify the reasons causing the formation of granuloma annulare. It is believed that this dermatosis is a skin reaction initiated by various factors.

There is reason to believe there is a connection between the development of granuloma and chronic diseases such as tuberculosis and rheumatism. Moreover, the granulomatous process is initiated not by infection, but by a peculiar reaction of the skin to the disease.

Endocrinopathies undoubtedly play a significant role in the development of granuloma. In particular, carbohydrate metabolism disorders. By the way, it should be mentioned that disruption of protein metabolism leads to the development. There is no reason to deny the connection between the development of granuloma and various connective tissue diseases (for example, etc.).

Granuloma annulare can develop at the site of tattoos, after removal of warts, or at the site of rashes after a history of warts. Sometimes granulomas form on scar tissue.

Clinical manifestations

In dermatology, it is customary to distinguish several clinical forms of anular granuloma:

subcutaneous;
localized;
disseminated;
perforated.

Subcutaneous form

Subcutaneous anular granuloma is most often observed in young children. After 7 years, this type of granuloma is extremely rare. Dermatosis manifests itself in the formation of multiple or single dermal (less often subcutaneous) nodes. Rashes with this form of dermatosis appear on the skin of the legs, forearms, hands and fingers, and especially often nodes form on the scalp in the scalp. Sometimes granulomas form in the eye area, usually on the upper eyelid.

Nodes located on the skin of the extremities can be either mobile or tightly connected to the underlying tissues. The knots on the head are almost always motionless.

Localized type

This is a common form of anular granuloma. In 90% of childhood patients, a localized form of the disease develops.

In most patients, a single lesion forms on the skin of the extremities. Sometimes there are several lesions on the skin, but their number is always limited.

Worth knowing! In 60% of patients, granulomas form on the hands or forearms, in 20% - on the feet and legs. In another 20%, rashes appear on other parts of the body, usually in the area of large joints.

The rashes are dense papules the color of healthy skin (sometimes slight redness is observed). Papules are located in the shape of an arc or a ring, and in the center of the lesion, the skin, as a rule, remains healthy.

Foci of granuloma can grow along the periphery, some of the rashes can resolve spontaneously and then recur again. Most often, granuloma rings have a diameter of 2 to 5 centimeters; in rare cases, lesions grow to very large sizes. The outlines of the lesions are almost always round; granulomas of irregular shape are rarely formed. The central part is usually somewhat sunken.

Disseminated type

This form of granuloma annulare occurs mainly in adult patients. Rashes appear all over the body in the form of papules of a purple hue or the color of healthy skin, i.e. in appearance they may resemble. Rashes most often appear on the skin of the limbs and torso.

This form of the disease is characterized by polymorphism of rashes; papules can be scattered or merge into extensive foci.

Perforating form

This is the rarest type of granuloma annulare, occurring in only 5% of all patients with this disease. Usually the rash appears on the fingers and the skin of the hands. The rash consists of papules with horny plugs and jelly-like contents. As the contents of the papules are released, the rashes transform into elements with a crater-shaped depression in the center, covered with crusts.

Later, at the site of the rash with a perforated granuloma, atrophic scars may develop - pale or, on the contrary, hyperpigmented, and sometimes may appear.

Important! With all forms of anular granuloma, there are no subjective sensations. The appearance of the rash is not accompanied by pain or itching.

Diagnostic methods

Since the clinical manifestations of granuloma annulare are quite specific, diagnosis, in most cases, does not cause difficulties. If the case is doubtful, then it is necessary to perform a skin biopsy and subsequent histological examination of the obtained material.

When examining a biopsy specimen under a microscope, foci of necrobiosis located in the connective tissue are revealed. Mucin deposits are observed in them; histiocytes, lymphocytes and multinucleated cells are present in the tissues. Signs of granulomatous inflammation are clearly visible in the dermis.

Treatment

Treatment of granuloma annulare is carried out using the following methods:

When concomitant diseases are identified (chronic infections, metabolic disorders, etc.), their persistent treatment is necessary.
Drugs are used to improve microcirculation - Retinol, Tocopherol, Ergocalciferol.
Vitamin therapy is prescribed - B vitamins, ascorbic acid.
A fairly effective technique consists of injecting foci of granuloma annulare with Dapsone, Triamcinolone Acetonide, and Hydroxychloroquine.
Ointments with a high concentration of topical steroids are used. These drugs are prescribed in short courses with breaks.
Granulomas are also treated with cold. For example, the affected skin is irrigated with chlorethyl until a layer of “frost” forms on the skin. The procedures are carried out once a week, the full course is 3-5 procedures for each of the granuloma lesions.

Treatment with traditional methods

Celandine tincture is used to treat the disease.

There are also folk recipes that can help in the treatment of granuloma annulare.

Treatment of granuloma with celandine tincture. You need to buy or prepare a 30% celandine tincture yourself and mix it with an equal amount of pharmaceutical glycerin. Soak a cotton pad or a piece of gauze in the resulting mixture and apply a compress to the lesions of granuloma annulare. Keep the compress for at least 2 hours. By the way, a plant such as celandine effectively helps with treatment, etc.

Treatment of granuloma with sea salt. Take sea salt, grind it in a coffee grinder to obtain a fine powder and mix with egg yolk until creamy. Apply to the affected areas for half an hour, then wash off the application and lubricate the skin with Vaseline or nourishing cream.

Prognosis and prevention

The prognosis for granuloma annulare is favorable. The disease can regress on its own; treatment with conservative methods is also quite effective.

Prevention of the formation of anular granulomas consists of timely detection and persistent treatment of chronic infectious diseases, metabolic disorders, as well as protecting the skin from damage.

Granuloma annulare is a benign, chronic and relapsing progressive skin disease. The lesions are distinguished by the ring-shaped nodules against the background of destruction of collagen fibers and granulomatous inflammatory reactions. They can occur regardless of gender and age.

Granuloma is considered an attempt by the body to limit or isolate an infectious, inflammatory process, or foreign body, possibly through a nonspecific immunological reaction.

Pathogenesis

The pathological process can last several months, or even several years. It presumably begins with a lymphocytic immune reaction, leading to activation of macrophages and degradation of connective tissue mediated cytokines , which leads to the formation of a lenticular papule, which has a clearly defined, somewhat atrophic retraction in the central part, which grows with remitting progression, sometimes accelerating, sometimes slowing down in growth.

The granuloma annulare itself is a plaque measuring 5 square cm or more, slightly rising above the surface of the healthy skin and only in the center aligning in tone with it. The skin easily gathers into folds, but around the sunken area there is a dense, waxy, shiny burgundy or slightly pinkish ring or crescent, which is not a very wide ridge (up to 2-3 mm). It may consist of individual grayish papules with pinkish rims that are not fused to the underlying layers of skin.

The rings are sharply defined, with their inner edges descending into sunken central areas. Thanks to palpation, a tumor-like neoplasm can be detected in the thickness of the epithelium, which gradually passes into the surrounding integument. In its structure, it has epithelioid cells and fibroblasts, which are surrounded on the periphery predominantly by lymphoid cells, as well as less common plasma cells and mast cells. The location of the round cell infiltrate is along the main course of the vessels, accompanied by the formation of powerful plexuses from argentophilic fibers. The separation of nodes occurs due to trabeculae and collagen fibers. The central parts are pronounced foci and destruction of elastic fibers. The walls of the vessels gradually thicken, endothelial proliferation is observed, which can lead to blockage of individual vessels.

Annular granulomas can be located in the deep layers of the skin itself and even in the subcutaneous fat. They are felt as a peculiar type of nodules, reminiscent of dense peas or beans, which do not change the structure of the skin on the surface.

Classification

Depending on the location and other features of granulomas, there are:

Subcutaneous - more often found in children, located on the scalp, near the eyes and on the limbs.
Plaque - usually occurs in women, they are characterized by the presence of erythematous, red-brown or purple plaques without ring-shaped rims.
Localized and disseminated - as a result of pathology, a single lesion can form or spread to other parts of the body.
Perforating - this type of dermatosis is quite rare and is characterized by the presence of plugs in the center of formations and gelatin-like discharge, as well as the formation of larger plaques, crusts and further scarring.
Interstitial form (with a mucin infiltrate between collagen fibers) and frontal form (in the center surrounded by histiocytes).

Causes

At the moment, the origin of granuloma annular or, in other words, anular is considered unclear. It is assumed that the basis of the granulomatous process may be allergic reactions or changes in tissue reactivity caused by stress , genetic factors or the course of such chronic diseases as:

acute rheumatic fever ;
viral infections ( , And , ).

The development of the disease may be associated with connective tissue diseases and carbohydrate metabolism disorders.

Scar tissue, animal and insect bites, and tattoo sites are more susceptible to pathology.

Symptoms

Granuloma annulare is usually localized:

on the back of the hands and feet;
on the fingers;
on the neck;
less often - on the buttocks and legs, on the elbows and forearms.

The course of the disease is not accompanied by subjective pain or discomfort.

Tests and diagnostics

Initially, it is necessary to study the clinical manifestations of the disease and collect anamnesis data.
Histological examination of a skin biopsy helps confirm the diagnosis of granuloma annulare. Differential diagnosis is carried out with erythematosis , lichen planus And Beck's sarcoid .

Treatment of granuloma annulare

Treatment can be carried out using x-rays, photoactive substances, arsenic, ointments with a high content of topical steroids (for example,). In addition, the patient may need:

correction of carbohydrate metabolism;
therapy with drugs that improve microcirculation;
course of multivitamins.

Treatment of granuloma annulare in children is the most gentle. Any medications should be used with caution and only after consultation with your family doctor. The use of or others may be recommended.

The doctors

Medicines

Drug therapy can be reduced to injecting lesions with drugs such as:

And Fluocinolone acetonide – glucocorticosteroid drugs with anti-inflammatory, antiallergic and immunosuppressive effects.
– has a bacteriostatic and immunosuppressive effect, inhibits enzymes and exhibits oxidizing properties.
Hydroxychloroquine – immunosuppressant with anti-inflammatory effect.

Procedures and operations

– there are cases where taking a sample by excision of a piece of tissue led to spontaneous spontaneous resolution of the granuloma.
Scarification – the product of the notches of the peripheral roller.
Laser therapy – elimination of skin defects thanks to hardware laser treatment.
– carrying out physiotherapeutic procedures, which are based on the use of low temperatures that cause the body’s response to hypothermia - an anti-inflammatory effect, normalization of metabolic processes, etc.

Prevention

To prevent the occurrence of cosmetic skin defects such as granuloma annulare, which can cause psychological discomfort, it is necessary:

carrying out timely diagnosis of infectious diseases;
healthy eating;
protecting the skin from damage.

Granuloma annulare in children

The disease in children manifests itself in the form of widespread benign granulomatous dermatosis. Foci of skin lesions in childhood most often develop spontaneously in the first years of life or after shingles or warts as a result of changes in the functioning of the immune system. For most, they are single - on the limbs or head (as in the presented photo of granuloma annulare in children), but can spread to other parts of the body, for example, joint bends.

If signs of the development of granulomas are detected, the initial treatment of the child should be aimed at treating concomitant chronic pathologies and correcting nutrition.

Diet for granuloma annulare

Since the etiology and pathogenesis of the granulomatous process are not fully understood, it is important to activate the internal forces of the body and normalize metabolism. This is possible thanks to diet correction and giving up bad habits (alcohol, smoking, irregular sleep).

Many nutritionists consider the main problem of modern society to be carbohydrate metabolism disorders caused by the consumption of large amounts of synthetic sugars and the availability of simple, easily digestible carbohydrates. Therefore, you should start your diet by reducing the consumption of refined sugar, confectionery, bakery and pasta products.

In addition, it is necessary to ensure the supply of all nutrients necessary for normal life - proteins, fats, natural sugars, vitamins. The diet should be balanced, consisting of fresh salads, fruits, cereals, meat and seafood. It is necessary to give preference to dietary methods of preparation - boiling, stewing, steaming.

Forecast

Ring-shaped plaques can resolve on their own. Spontaneous regression is observed in 75% of cases and takes up to 2 years. There are known cases of relapse - up to 40%, and usually the lesions appear in the same place.

List of sources

Wolf K, Lowell A, Goldsmith S, et al. Fitzpatrick's dermatology in clinical practice. M.: 2012. - 401 S.
Habif T.T. Skin diseases: Diagnosis and treatment. M.: MEDpress-inform, 2006. - 574 pp.

Granuloma annulare in children is a benign process accompanied by the formation of inflammatory elements on the skin, most often located in the form of irregularly shaped rings.

This is always an acquired, slowly progressive disease, which is characterized by the formation of inflamed areas on the skin in the form of small, pink granulomas. These are small, dense, hemispherical nodules that rise above the surface of the skin and range in size from 1 to 5 mm. The surface of the skin elements is shiny and smooth. They have the ability to periodically appear and disappear on their own.

Causes and classification

This skin disease is called dermatosis, which can have many causes. Provoking factors for the onset of the disease include chronic bacterial infections, endocrine disorders, hypovitaminosis, viruses and allergic diseases.

Depending on the prevalence and degree of damage to the layers of the skin, the following types of disease are distinguished:

Localized is the most common form of the disease.
Papular - small papules are formed.
Deep subcutaneous process.
Disseminated - when there are lesions spread throughout the body.
Perforating.

Features of the disease

The localized form is manifested by granulomas located on the skin in the form of rings, half rings on the hands, feet, legs and forearms.

Occasionally, damage to the scalp and area around the eyes is observed. Small lesions tend to merge, and large lesions can reach a size of 5–7 cm. In the center of ring-shaped granulomas there is bluish or purple skin. There is usually no pain, itching or other unpleasant sensations.

The papular form of granuloma annulare is distinguished by the appearance of nodules located isolated from each other. These formations do not merge with each other and are always clearly demarcated from each other.

With deep granuloma annulare, the nodules are located under the skin, but the epidermis is not affected. It occurs most often in a child under 6 years of age and is located under the skin of the legs, forearms, elbows, dorsum of the hands and sometimes the scalp. The subcutaneous tissue around the eyes may suffer, and the upper eyelid also periodically suffers.

A lesion located subcutaneously is usually easily displaced. Only on the scalp are the nodules motionless. Surgical treatment of this pathology is not effective, because the process soon recurs, i.e. nodules under the skin form again.

In children, in more than 90% of cases, the disease is a localized form.

In a disseminated process, the lesions are located throughout the skin of the entire body. Adults are most often affected; children are extremely rare.

Perforating granuloma annulare is located on the back of the hands and fingers. More often the disease affects children. The ring-shaped lesion has a crust or plug in the center, after removal of which a jelly-like yellowish content is released. Has a tendency to merge. After the resorption of these formations, thinned pale areas remain on the skin, which means the destruction of collagen.

Diagnostics

To make a diagnosis, the clinical picture is of primary importance. In difficult cases, histological examination is used.

Differential diagnosis

Granuloma annulare must be differentiated from the following conditions:

Necrobiotic foci. Formation of nodules on the skin due to carbohydrate metabolism disorders, which, when fused, form plaques, mainly on the legs, with a shiny surface.
Brown and blue knots. They are more common on the face in adults, with sarcoidosis.
Lichen planus. May be accompanied by itching. The skin elements are not ring-shaped, but polygonal in shape and have a brighter pink-violet color.
Elevating erythema. Located mainly around the joints, they have clear signs of inflammation. The rash is usually more numerous than with granuloma annulare.
Rheumatoid nodules. Often painful when palpated, and more deeply located, accompanied by the appearance of acute phase indicators of inflammation in the analysis, joint damage, weakness and fever.
Pyogenic granuloma. Benign vascular tumor, or hemangioma of a lobular structure. Pyogenic granuloma occurs most often in children and adolescents. It affects not only the skin of the scalp and upper extremities. Pyogenic granuloma (bothryomycomoma) likes to be located on the mucous membrane of the esophagus, gums, lips, larynx, nose, conjunctiva, and cornea. Provoking factors can be trauma, burns, infections and skin diseases. Pyogenic granuloma is characterized by excessive proliferation of capillaries.

Treatment

Treatment has the following objectives:

Cause a reduction in rashes.
Prevent relapses of the disease.

It must be remembered that granuloma annulare can disappear on its own.
Attention must be paid to:

Treatment of chronic foci of infection;
Corrections of carbohydrate metabolism.

For local treatment, cream and ointment with glucocorticoids and non-steroidal anti-inflammatory drugs are used.
Glucocorticoid topical agents:

hydrocortisone;
alklometasone dipropionate;
betamethasone dipropionate;
betamethasone valerate;
methylprednisolone aceponate;
mometasone furoate;
clobetasol propionate.

Non-steroidal local agents:

indomethacin;
phenylbutazone;
naftalan.

Systemic vitamin therapy:

tocopherol;
retinol;
ascorbic acid;
routine

Non-drug therapy:

laser therapy;
irrigation with chlorethyl until persistent “frost” is obtained;
extinguishing with liquid nitrogen.

Before performing physiotherapeutic treatment, consultation with a phthisiatrician, ENT doctor, endocrinologist, infectious disease specialist or pediatrician is necessary.

The disease is treated on an outpatient basis. As a rule, there are no indications for hospitalization. There are no specific methods of prevention for the disease. You can see what granuloma annulare looks like in the photo.

ethnoscience

When treating any form of annular erythema, it is imperative to remember that one of the triggers of the disease is the allergic component. The following medicinal plants have a good effect: celandine, lemon balm, yarrow, St. John's wort, lingonberry, rose hip, rowan, mistletoe, nettle and elderberry.

But, they can also cause a severe allergic reaction. Therefore, it is imperative to coordinate your desire to be treated with folk remedies with your doctor.

Granuloma annulare

Cetrin 1t. in the morning;

Ketotifen 1 t. In the evening;

Urine and blood count tests are normal.

1) Sanitation of the oral cavity:

Nose: E.coli growth rate

Didn't treat it with anything.

Granuloma annulare

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Granuloma annulare in children treatment Komarovsky

Granuloma annulare

Please write what treatment the professor prescribed for you!

I’ll rewrite what Prof. Glukhenky wrote:

Examination (lungs, lymph nodes, abdominal organs, ultrasound);

Vitamin A (1k x 1r/3 days) 10 capsules;

Cetrin 1t. in the morning;

Ketotifen 1 t. In the evening;

Calcium gluconate 0.5 t x 2 times / day (3 weeks);

Aquadetrim 2 drops x 2 times/day (3 weeks);

Externally - ointment according to prescription - 2 rubles / day.

In March, my 7-year-old daughter was diagnosed with an annular granuloma on her ankle, measuring 17*17mm; from March to June it doubled in size.

We just arrived from the regional hospital, where we were undergoing examination.

We excluded: tuberculosis (diaskin test was performed), diabetes mellitus (blood was taken for sugar before and after meals).

Urine and blood count tests are normal.

Throat swab: 10*3 S.aureus, 10*4 Str.viridans.

Blood ELISA for chlamydia, viruses, Giardia, Lyme breliosis NEGATIVE.

Blood PCR for CMV, herpes, Epstein-Barr NEGATIVE.

Upon discharge, the following treatment was prescribed:

1) Sanitation of the oral cavity:

Amoxiclav 250 mg * 3 r / day - 10 days + rinsing the mouth with furatsilin for 10 days, then imudon 1 t * 1 r / day - 10 days.

2) IM Bicillin-5 750 thousand units No. 6 with an interval of 3 weeks. Control of a throat smear for flora and sensation.

As the doctor said, since systemic diseases have been ruled out, then most likely granuloma annulare arose as a result of a streptococcal infection.

1) Cetrin 1t at night - 10 days

2) Advantan cream on an occlusive dressing at night - 10 days.

I am completely confused about what is normal and what is not.

Pharynx: no growth of microflora was obtained,

Nose: E.coli growth rate

Resistance: ampicillin, amoxicillin, acythromycin, oceanacillin.

Didn't treat it with anything.

Help me decide, please.

Granuloma annulare

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http://www.komarovskiy.net/forum/viewtopic.php?t=18517

Granuloma annulare

Annular or anular granuloma is a chronic skin disease manifested by nodular round rashes.

The pathological process is a nonspecific immune reaction in response to an irritant.

The disease may be asymptomatic. Most often occurs in women and children.

Causes of the disease

The etiology of anular granuloma is unknown. The following factors are believed to lead to the development of the disease:

Granuloma annulare can be typical or atypical. The latter has varieties:

Sometimes the formation appears on the site of scars and tattoos.

Symptoms of anular granuloma

The pathological process begins with the appearance of single lacquered, pale pink papules. The elements of the rash do not itch or cause pain.

After some time, the papules increase in size, forming a large round plaque. The plaque can gradually increase in size up to 5-10 cm in diameter.

The formation is unevenly colored: the middle may be pale pink (normal healthy color) or bluish, and the edges may be bright red. Neighboring plaques may have different stages of development. Ulceration of the rash elements occurs very rarely.

The duration of the disease is from six months to 2 years.

dorsum of hands, elbows, knees and feet;
buttocks;
shoulders and forearms;
chest and stomach;
rarely - on the face.

Disseminated granuloma develops in 15% of patients; such a disease is difficult to find in children. Round pink or purple rash elements form across the entire surface of the body.

Features of the disease in childhood

In children, the disease occurs as benign granulomatous dermatitis. This usually occurs against the background of immunodeficiency.

More common localized granuloma is a single lesion 2-5 cm in diameter. Such rashes tend to grow peripherally. Relapse of the disease occurs in the same place. The epidermis is not affected.

Subcutaneous form in a child

Subcutaneous granuloma is common in preschool children.

Symptoms: deep subcutaneous nodes (from one to several pieces).

They are mobile and can be fused to the fascia or periosteum.

The formations are very similar to the manifestations of juvenile rheumatoid arthritis, but there is no connection between these diseases.

The rashes are localized, as in adults, on the back of the arms and legs, sometimes the joints, forearms, area around the eyes and scalp are affected.

Diagnosis of the disease

The disease has a fairly specific clinical picture, so the doctor can make a diagnosis based on examination.

Additionally, the patient needs to undergo a general and biochemical blood test, an analysis for the presence of HPV in the body, blood for STIs and syphilis.

Differential diagnosis is carried out with syphilis, lichen, necrobiosis lipoidica, sarcoidosis, rheumatic nodules, Darier's annular erythema.

If symptoms of the disease appear, you should consult a dermatologist.

Principles of therapy for anular granuloma

Data on the effectiveness of treatment are based on the observational method. The disease is asymptomatic, so therapy is needed only to remove the cosmetic defect.

Sometimes the doctor advises a wait-and-see approach: the lesions go away on their own within 6-18 months. It is believed that the effect of medications occurs only against the background of spontaneous cure of the disease.

Drugs that are used in the treatment of granuloma annulare:

Additionally, a diet with limited carbohydrates is prescribed. You cannot eat flour products, sweets, pasta, fast food, etc.

It is important for the patient to know that his disease is curable on its own. Despite the unpleasant appearance of the rash, it is better to allow the granuloma to resolve naturally, because any of the above methods carries with it side effects.

If a person nevertheless chooses therapeutic treatment, it should be under the supervision of a doctor.