Granuloma annulare (GA) is a chronic inflammatory skin disease characterized by a sometimes-itchy rash with reddish bumps organized in a ring- or circular-shaped pattern. Although it is a benign condition, it is unsightly and occurs in patients of all ages, though more commonly in females. Treatment regimens vary, and the condition has a tendency to resolve on its own without the use of medication.
Types of Granuloma Annulare
There are two types of granuloma annulare: localized and general. Localized GA is typically asymptomatic, and responds much better to treatment than general GA. The biggest concern with general GA is aesthetic, as it covers a much greater area of the skin and can be unsightly and itchy.
Corticosteroids possess anti-inflammatory properties, modifying the body’s immune response to diverse stimuli. Examples of corticosteroids used in the treatment of localized granuloma annulare include Clobetasol and Triamcinolone acetonide. They can come in either a cream form or as an injection, the latter of which is used on thicker skin lesions and more severe symptoms.
In cream form, the amount used topically is dependent on the severity of the condition. It is recommended that the sufferer use an adhesive bandage to cover the lesion, as this makes the steroid cream more concentrated and thus more potent.
Retinoids are derived from vitamin A. They encourage cellular differentiation, are antiproliferative (inhibit cell growth), and serve as immunomodulators. One example of such a medication is isotretinoin (Accutane), an oral agent designed for treating serious skin conditions. Isotretinoin can be prescribed only by a physician and used under his direction.
Mostly effective in treating severe cases of general granuloma annulare, light therapy called psoralen plus ultraviolet A (PUVA) is an option. It works by combining psoralens (a type of drug) with phototherapy, the latter of which has been known to treat a variety of skin conditions such as acne and jaundice.
Freezing the lesions off, known as cryotherapy, is done through the application of liquid nitrogen directly to the lesion with a small cotton-tipped applicator or other small device. The frozen lesion is then easier to remove, and inhibits the growth of new cells.