Granuloma is a common chronic inflammatory skin disease. Here, tough papules (skin nodules) form, which occur particularly on the backs of the hands and feet, with children/adolescents being affected more often than adults.
What is a granuloma?
According to abbreviationfinder.org, a granuloma is a lump-like, mostly benign new growth of skin tissue.
Granulomas are first noticeable on an area of skin by means of rough papules (nodules) covering a few millimeters, which can appear in small groups. They are narrowly defined, reddish or skin-colored in color and have smooth surfaces. The nodules are stubborn, but fortunately completely harmless. Within a few weeks, the papules can spread.
A ring typically forms, which can grow to between one to several centimeters. The term “annulare” (Latin for ring-shaped) in the identifier of this disease indicates this peculiarity. While the ring of nodules is still being enlarged, they are already healing again in the inner area of the ring.
These extremely stubborn papules often withstand a number of treatment attempts, but are absolutely harmless and do not cause itching or pain and do not affect any internal organs. Why the granuloma (Latin “granulum” = granules) occurs in some people at all is still completely unclear.
According to the current state of knowledge, specific pathogens do not play a role, and this disease is not contagious. During the middle of the 20th century a possible connection with diabetes mellitus (diabetes) was discussed. However, there are no current studies on this opinion.
Other diseases that can also trigger granulomas are: syphilis, rheumatic fever, schistosomiasis, cutaneous leishmaniasis, various skin fungal diseases and listeriosis. Tuberculosis and the rare occurrence of leprosy can also lead to granulomas.
Symptoms, Ailments & Signs
A granuloma can primarily be recognized by the visible changes in the skin. Typically, a ring about one centimeter in diameter forms on the skin, on which several pustules or nodules develop. This ring usually develops overnight and increases in size during the first few days of the disease.
During the growth phase, the pustules inside the ring heal, resulting in the typical red and white appearance. In the course of this, further rings can form in the area of the ring or in other parts of the body. The nodules themselves are sturdy and do not cause any pain. They have a showy appearance and grow quickly, but usually do not reproduce.
Depending on the causative disease, a granuloma can be associated with other symptoms. If the symptoms are based on syphilis, for example, an increasing feeling of illness occurs as the disease progresses and further skin changes occur, some of which can be painful and itchy.
If rheumatic fever is the cause, pustules can cause severe itching. Joint and bone pain can also occur. Similar symptoms occur when the granuloma occurs in connection with tuberculosis, leprosy, listeriosis or a skin fungal disease.
Diagnosis & History
If the papules are arranged in a ring, the dermatologist can already diagnose a granuloma annulare if he intensively examines the affected skin. If the individual skin changes are atypical, a histological examination of a skin sample (biopsy) must be carried out under a microscope. If there is a granuloma annular disease, a blood test should be used to clarify whether a suspicion of diabetes mellitus can be ruled out.
Without intensive treatment, this ring-like formation of papules can persist for months or even years. Pain of any kind or possible itching are not part of a granuloma annulare. In particular, the affected skin areas are the backs of feet and hands, ankles and wrists, as well as the extensor sides of toes and fingers.
Occasionally, such skin changes are also noticed on the lower legs and arms. In various cases, only a single ring of papules develops, but the affected person often complains of several rings of nodules lying next to one another.
In adults, disseminated (scattered) nodules may appear on the upper body and extremities at the same time. These rarely form ring structures, but they can spread laterally. The name of this special form is “granuloma annulare disseminatum”.
The granuloma usually leads to the formation of papules. These look very unattractive and grow relatively quickly. Neighboring regions of the body can also be affected by the papules if they continue to spread. However, there is no itching or pain, so that the patient primarily has aesthetic problems.
The unattractive malformations usually lead to reduced self-esteem and often to inferiority complexes. A granuloma can also lead to mental depression and discomfort. The treatment of the disease is causal and always depends on the underlying disease. Complications or pain are rare.
In most cases there are no scars either. The treatment is carried out by taking medication or by irradiating the affected area. The granuloma then regresses relatively quickly and leaves no complications. If the granuloma is not treated, it will not usually go away on its own and can remain on the patient’s skin for several months.
When should you go to the doctor?
If there are changes in the skin, these abnormalities should be observed. Since the skin changes are symptom-free from a medical point of view, an immediate visit to the doctor is not necessary. In many cases, the granulomas regress on their own within a few days. If the symptoms persist for weeks or months, you should see a doctor for a check-up.
If there is unusual redness, swelling, growths or lumps on the skin, this should be clarified by a doctor. Changes on the backs of the hands or feet as well as the wrists or ankles should be checked in particular.
If the abnormalities of the skin spread or increase in intensity, a doctor should be consulted. If the affected person complains of itching and open wounds appear as a result, special caution is required. If the wounds cannot be treated in a sterile manner on your own responsibility, you should see a doctor.
In the case of inflammation, pus formation or heat development on the skin, a doctor is required. Numbness or sensory disturbances should be evaluated and treated. If psychological problems arise as a result of the abnormalities, the help of a therapist should be sought. If melancholic or depressive behavior, mood swings or an aggressive appearance occurs, a doctor is needed. In the case of compulsive behavioral tendencies or an increased stress experience, a doctor should be consulted.
Treatment & Therapy
Since a granuloma is an absolutely harmless skin disease, treatment is not absolutely necessary from the doctor’s point of view. In particular, children often feel little affected by the symptoms, since the nodules in most of the affected children heal without scarring and often spontaneously over a period of a few months to a few years. Adult patients, on the other hand, often feel very disturbed. In addition, such nodular diseases in adults only rarely regress on their own.
Doctors usually recommend cortisone therapy or alternative anti-inflammatory agents in the form of ointments or creams. Such active ingredients can, for example, be used to enhance the effect by means of special film bandages (occlusive therapy). Injecting a cortisone preparation or freezing with liquid nitrogen ( cryotherapy ) cannot heal the papules sufficiently and they are also painful.
For adults, on the other hand, a cream-PUVA therapy (light treatment/( phototherapy ) is recommended. Here, the doctor treating you carries out controlled UVA light irradiation for a few minutes in a special phototherapy cabin. The affected skin areas are first treated with a Cream (Methoxysporalen), which increases the anti-inflammatory effect of UVA light. If this cream-PUVA therapy is continued for a few months, the nodules can often be permanently eliminated. Alternatively, the therapy can be given in tablet form.
Outlook & Forecast
The prognosis of a granuloma is favorable. From a medical point of view, it is a harmless skin change that can regress on its own and does not represent a disease. Granulomas often develop due to other diseases, emotional problems or necessary hygiene measures. With a change in lifestyle, regular cosmetic treatments or self-treatment, the affected person can remove the granulomas or prevent their formation.
Drug treatment is not necessary in most cases, but can be used. The cause of a granuloma is combated by anti-inflammatory drugs and you are free of symptoms. Patients who want to avoid preparations containing cortisone can use natural remedies. With a healthy lifestyle, the intake of sufficient fluids and a good diet, improvements in the complexion normally develop.
A quantity of two liters should be drunk daily. As a result, dirt or the smallest particles are washed out of the skin and transported away. If you clean your body every day and change your clothes regularly, the granulomas usually recede. The number of new growths often decreases at the same time. If there are complications, the healing process will be longer. Papules may also form. In severe cases, scars remain on the skin that represent a cosmetic blemish.
As with many other skin diseases, the prevention of granulomas can consist of practicing basic personal hygiene. In addition, a general healthy lifestyle with plenty of sport and exercise and a healthy diet is a good guarantee for preventing skin diseases. Since various other diseases can lead to granulomas (see Causes section), individual disease prevention should be the top priority here.
In the case of a granuloma, there are hardly any aftercare options. The person concerned is primarily dependent on direct and correct treatment by a doctor in order to prevent symptoms and complications. As a rule, self-healing cannot occur. However, the disease has no negative impact on life expectancy.
Early diagnosis and treatment always have a positive effect on the further course of the disease. As a rule, those affected by a granuloma are dependent on taking medication and using creams and ointments. It is important to ensure that it is taken regularly, whereby interactions must also be taken into account.
In cases of doubt, a doctor should always be consulted immediately. Furthermore, the creams should also be instructed regularly to alleviate the symptoms. Since a granuloma can also have a very negative effect on the aesthetics of the affected person and reduce it.
Patients are therefore often dependent on psychological support from friends and family to counteract these symptoms. Contact with other people affected can also be very useful. This often results in the exchange of information, which can make everyday life easier.
You can do that yourself
Even if granulomas are generally considered not to require treatment, those affected often see things differently. Depending on the location, the skin growths are very annoying. The result is itching, dry skin regions, sore spots and reduced quality of life. This can have a negative effect on the psyche of the person concerned.
In addition, granulomas are usually visually conspicuous and can thus become another reason for depressive behavior. In this case, it is urgently advisable to consult a psychotherapist. Psychological care offers the sufferer the opportunity to express themselves without shame, without the direct environment learning about the weakened self-confidence.
The person concerned can also try to relieve the accompanying symptoms of the skin knot by self-help. If cold compresses do not inhibit the itching and the thought goes in the direction of antipruritic ointments and creams, this should be discussed in advance with the doctor treating you. Whenever it comes to using or ingesting any medicinal product, this advice should be followed urgently as there is a possibility of an allergic reaction.
Colored skin changes can be covered with make-up. However, there must be no open spots to avoid inflammation. Depending on the size and location of the granuloma, it can be padded with corn plasters or something similar. This can help, especially in chafing areas.