Granuloma

In which Granuloma it is a common chronic inflammatory skin disease. This results in the formation of rough papules (skin nodules), which occur in particular on the back of the hand and foot, whereby children / adolescents are more often affected than adults.

What is a granuloma?

A granuloma can primarily be recognized by the visible change in the skin. Typically, a ring about one centimeter in diameter forms on the skin on which several pustules or nodules appear.
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Granuloma is a pod-like, usually benign, new formation of skin tissue.

Granulomas are initially noticeable on an area of ​​the skin by means of rough papules (nodules) that cover a few millimeters and that can appear in small groups. They are narrowly defined, reddish or skin-colored and have smooth surfaces. The nodules are stubborn, but fortunately completely harmless. The papules can spread within a few weeks.

Typically, a ring forms which can grow to between one and several centimeters. The term "annulare" (Latin for ring-shaped) in the description of this disease indicates this characteristic. During the enlargement of the nodular ring, they heal again in the inner area of ​​the ring.

causes

These extremely stubborn papules often withstand numerous attempts at treatment, but are absolutely harmless and cause neither itching nor pain and do not affect any internal organs. Why the granuloma (Latin "granulum" = grain) occurs in some people at all is currently completely unclear.

According to current knowledge, special pathogens do not play a role, and this disease is not contagious. A possible connection with diabetes mellitus was discussed during the middle of the 20th century. However, there are currently no current studies on this opinion.

Other diseases that can also trigger granulomas are: syphilis, rheumatic fever, schistosomiasis, cutaneous leishmaniasis, various fungal skin 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 change in the skin. Typically, a ring about one centimeter in diameter forms on the skin on which several pustules or nodules appear. This ring usually develops overnight and increases in size in the first few days of the disease.

During the growth phase, the pustules inside the ring heal, creating the typical red and white appearance. In the course of the process, further rings can appear in the area of ​​the ring or in other parts of the body. The nodules themselves are robust and do not cause any pain. They are showy in appearance and grow quickly, but usually do not reproduce.

Depending on the underlying 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 complaints occur when the granuloma occurs in connection with tuberculosis, leprosy, listeriosis or a skin fungal disease.

Diagnosis & course

If the papules are arranged in a ring, the dermatologist can diagnose granuloma annulare by examining the affected skin intensively. If the individual skin changes are atypical, a tissue (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 carried out to determine whether a suspicion of diabetes mellitus can be ruled out.

Without intensive treatment, this ring-shaped papule arrangement 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 the feet and hands, ankles and wrists as well as the extended sides of the toes and fingers.

Occasionally, skin changes like this are also noticed on the lower legs and arms. In various cases only a single ring of papules develops, but often affected people also complain of several adjacent nodular rings.

In adults it can happen that disseminated (scattered) nodules appear on the upper body and on the extremities at the same time. These rarely form ring structures but can spread laterally. The name of this special form is "Granuloma annulare disseminatum".

Complications

The granuloma usually leads to the formation of papules. These look very unattractive and grow relatively quickly. The 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 primarily aesthetic complaints occur for the patient.

The unattractive malformations usually lead to a reduced self-esteem and not infrequently to inferiority complexes. A granuloma can also lead to mental depression and symptoms. The treatment of the disease is causal and always depends on the underlying disease. There are rarely any particular complications or pain.

In most cases, there are no scars either. The treatment takes place by taking medication or by irradiating the affected area. The granuloma then regresses relatively quickly and does not leave any complications. If the granuloma is left untreated, 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 the skin changes, these abnormalities should be observed. Since the skin changes are symptom-free from a medical point of view, a doctor's visit is not necessary immediately. 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, growth or lump formation on the skin, this should be clarified by a doctor. Changes on the back of the hand or foot as well as the wrists or ankles should be monitored in particular.

If the abnormalities on the skin spread or if they increase in intensity, a doctor should be consulted. If the person concerned complains of itching and this causes open wounds, particular caution is required. If the wounds cannot be treated sterile on their own responsibility, a doctor should be consulted.

A doctor is needed if there is inflammation, pus formation or heat build-up on the skin. Numbness or sensory disorders should be investigated and treated. If the abnormalities cause psychological problems, the help of a therapist should be sought. A doctor is required if melancholic or depressive behavior, mood swings or an aggressive demeanor occur. A doctor should be consulted in the case of compulsive behavioral tendencies or an increased experience of stress.

Doctors & therapists in your area

Treatment & Therapy

Since a granuloma is an absolutely harmless skin disorder, the doctor does not necessarily need treatment. In particular, children often feel little affected by the symptoms, since the nodules in most of the affected children heal without scars and often spontaneously over a few months to a few years. Adult patients, on the other hand, often feel very disturbed. In addition, such nodular diseases rarely regress on their own in adults.

Doctors usually recommend a cortisone preparation therapy or alternative anti-inflammatory agents in the form of ointments or creams. Such active ingredients can be used, for example, to intensify the effect by means of special film bandages (occlusive therapy). Injecting a cortisone preparation or freezing it with liquid nitrogen (cryotherapy) cannot heal the papules sufficiently and are also painful.

For adults, on the other hand, we recommend a cream PUVA therapy (light treatment / (phototherapy). Here, the attending physician carries out the controlled UVA light irradiation for a few minutes within a special phototherapy cabin 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 removed. Alternatively, the therapy can be in tablet form.

Outlook & forecast

The prognosis for a granuloma is favorable. From a medical point of view, it is a harmless skin change that can recede independently and is not a disease value. Often, granulomas develop due to other illnesses, emotional problems or when hygiene measures are necessary. With a change in lifestyle, regular cosmetic treatments or self-treatment, the person affected can remove the granulomas or prevent them from developing.

In most cases, drug treatment is not necessary, but it can be used. The cause of a granuloma is combated by anti-inflammatory drugs and symptoms are eliminated. Patients who do not want to use cortisone-containing preparations can use natural remedies. With a healthy lifestyle, the intake of sufficient fluids and a good diet, improvements in the complexion of the skin usually develop.

A quantity of two liters should be drunk daily. As a result, dirt or tiny particles are washed out of the skin and transported away. If you clean your body daily and change your clothes regularly, the granulomas usually recede. The number of new formations often decreases at the same time. If complications arise, the healing process can be expected to lengthen. In addition, papules can form. In severe cases, scars remain on the skin, which are a cosmetic blemish.

prevention

As with many other skin diseases, the prevention of granulomas can consist of basic personal hygiene. In addition, a generally healthy lifestyle with plenty of sport and exercise, as well as a healthy diet, is a good guarantee for preventing skin diseases. Since various other diseases can lead to granulomas (see section causes), individual disease prevention should come first.

Aftercare

With a granuloma, there are hardly any follow-up options. The affected person is primarily dependent on direct and correct treatment by a doctor in order to prevent complaints and complications. As a rule, self-healing cannot occur. However, the disease does not have a 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 with granuloma are dependent on the intake of medication and the use of creams and ointments. It is important to ensure that it is taken regularly, and interactions must also be taken into account.

In case of doubt, a doctor should always be consulted directly. Furthermore, the creams should also be used regularly to alleviate the discomfort. Because a granuloma can also have a very negative effect on the aesthetics of the person affected and reduce them.

Patients therefore often need psychological support from friends and family to counteract these symptoms. Contact with other affected persons can also be very useful. This often involves exchanging information that can make everyday life easier.

You can do that yourself

Even if granulomas are generally not considered to require treatment, those affected often see things differently. Depending on the location, the skin growths are very annoying. Itching, dry areas of the skin, sore spots and impairment of the quality of life occur. 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 strongly recommended to see a psychotherapist. Psychological support offers the sufferer the opportunity to express themselves free of shame, without the immediate environment knowing about the weakened self-confidence.

The person affected can also try to help themselves to alleviate the symptoms accompanying the skin lump. If cold compresses do not inhibit the itching and the idea is to use ointments and creams to relieve itching, this should be discussed with the attending physician in advance. Whenever it comes to using or ingesting medical devices, this advice should be followed urgently as there is a possibility of an allergic reaction.

Changes in the color of the skin can be covered with make-up. However, there must not be any open areas to avoid inflammation. Depending on the size and location of the granuloma, it can be padded with corn plasters or something similar. This can provide a remedy, especially on chafing areas.