Granuloma is a frequently occurring chronic inflammatory skin disease. Here, rough papules (skin nodules) are formed, which occur in particular on the back of the hand and foot, whereby children / adolescents are affected more often than adults.
What is a granuloma?
A granuloma is a nodule-like, usually benign neoplasm of tissue of the skin. Granulomas first become noticeable on an area of skin by means of dermal papules (nodules) a few millimeters in circumference, which may appear in small groups. They are narrowly circumscribed, reddish or skin-colored in color, and have smooth surfaces. The nodules are persistent, but fortunately completely harmless. Within a few weeks, the papules may spread. Typically, a ring is formed, which can grow to between one and several centimeters. This peculiarity is indicated by the term “anulare” (Latin for ring-shaped) in the identification of this disease. While the nodule ring is still enlarging, they are already healing in the inner part of the ring.
Causes
These extremely persistent papules often resist quite a few treatment attempts, but they are absolutely harmless and do not cause itching or pain and do not affect any internal organs. Why the granuloma (Latin “granulum” = granule) occurs at all in some individuals is currently still completely unclear. According to the current state of knowledge, specific pathogens do not play a role; moreover, this disease is not contagious. During the middle of the 20th century, a possible connection with diabetes mellitus (diabetes) was under discussion. However, current studies do not exist on this opinion at present. Other diseases that can also cause granulomas are: Syphilis, rheumatic fever, schistosomiasis, cutaneous leishmaniasis, various fungal skin diseases and listeriosis. Tuberculosis and the rarely occurring leprosy can also cause granulomas.
Symptoms, complaints, and signs
A granuloma can be recognized primarily 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 during the first few days of the disease. During the growth phase, the pustules inside the ring heal, giving the typical red and white appearance. As the disease progresses, additional rings may develop around the ring or in other areas of the body. The nodules themselves are robust and do not cause any pain. They have a conspicuous appearance and grow rapidly, but usually do not multiply. Depending on the causative disease, a granuloma may be associated with other symptoms. If the symptoms are based on syphilis, for example, an increasing feeling of illness occurs in the course of the disease and further skin changes occur, some of which may be painful and itchy. If rheumatic fever is the cause, pustules can cause severe itching. In addition, joint and bone pain may occur. Similar symptoms occur when the granuloma is associated with tuberculosis, leprosy, listeriosis, or a fungal skin disease.
Diagnosis and course
If the papules are arranged in a ring, the dermatologist can already diagnose granuloma anulare by intensively inspecting the affected skin. If the individual skin changes are atypically pronounced, a fine-tissue (histologic) examination of a skin sample (biopsy) must be performed, which is done under a microscope. If granuloma anulare is present, a blood test should be performed to determine whether diabetes mellitus is suspected. Without intensive treatment, this ring-shaped papule arrangement can persist for months or even years. Pain of any kind or possible itching, are not components of a granuloma anulare. In particular, the affected skin areas are the backs of the feet and hands, ankles and wrists, and also the extensor sides of toes and fingers. Occasionally, such skin changes are also noticed on the lower legs and arms. In some cases, only a single ring of papules develops, but often affected individuals complain about several rings of nodules lying next to each other.In adults, disseminated nodules may appear at the same time on the upper body and extremities. These form only extremely rarely ring structures but can spread laterally. The name of this special form is “granuloma anulare disseminatum”.
Complications
The granuloma usually results in the formation of papules. These look very unattractive and grow relatively quickly. Neighboring regions on the body may also be affected by the papules if they continue to spread. However, there is no itching or pain, so that the patient experiences primarily aesthetic discomfort. The unattractive deformities usually result in a lowered self-esteem and not infrequently in inferiority complexes. In addition, granuloma can also lead to psychological depression and discomfort. The treatment of the disease is causal and always depends on the underlying disease. There are rarely any particular complications or pain. Also scars do not develop in most cases. Treatment is carried out by taking medication or by irradiating the affected area. The granuloma then recedes relatively quickly and leaves no complications. If the granuloma is not treated, it will usually not disappear on its own and may remain on the patient’s skin for several months in the process.
When should you go to the doctor?
If there are changes in the skin, these abnormalities should be observed. Since the skin changes are asymptomatic from a medical point of view, a visit to the doctor 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, a check-up visit to a doctor should be made. If there is unusual redness, swelling, growths or lumps on the skin, this should be clarified by a doctor. Changes on the back of the hands or feet and on 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 care should be taken. If the wounds cannot be treated sterilely on one’s own responsibility, a visit to the doctor should be made. In the case of inflammation, pus formation or heat development on the skin, a doctor is required. Numbness or sensory disturbances should be examined and treated. If psychological problems arise due to the abnormalities, the help of a therapist should be sought. If melancholic or depressive behavior, mood swings or an aggressive demeanor occur, a physician is needed. If there are obsessive behavioral tendencies or an increased experience of stress, a doctor should be consulted.
Treatment and therapy
Since a granuloma is an absolutely harmless disease of the skin, from the doctor’s point of view, treatment is not mandatory. In particular, children often feel little disturbed by the symptoms, since the nodules heal without scarring and often spontaneously during a few months to a few years in most of the affected children. Adult patients, on the other hand, often feel very disturbed. In addition, such nodular diseases in adults only extremely rarely regress on their own. Doctors usually recommend cortisone therapy or alternative anti-inflammatory agents in the form of ointments or creams. Such agents can be used, for example, to enhance the effect by means of special film dressings (occlusive therapy). Injection of a cortisone preparation or icing by means of liquid nitrogen (cryotherapy) may also not allow the papules to heal sufficiently and are also painful. On the other hand, cream PUVA therapy (light treatment/phototherapy) is recommended for adults. In this case, the attending physician performs controlled UVA light irradiation for a few minutes inside a special phototherapy cabin. The affected areas of the skin are first treated with a cream (methoxysporalen), which increases the anti-inflammatory effect of the UVA light. If this cream-PUVA therapy is continued over a few months, the nodules can often be permanently eliminated. Alternatively, the therapy can be given in tablet form.
Outlook and prognosis
The prognosis of 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 value. Often granulomas develop due to other diseases, emotional problems or when hygiene measures are necessary. With a change in lifestyle, regular cosmetic treatments or in a self-treatment, the affected person can remove the granulomas or prevent their development. Drug treatment is not necessary in most cases, but can be used. Anti-inflammatory drugs fight the cause of a granuloma and freedom from symptoms occurs. Patients who wish to avoid cortisone-containing preparations can use natural remedies. With a healthy lifestyle, the intake of sufficient fluids and a good diet, improvements in the appearance of the skin normally already develop. An amount of two liters should be drunk daily. This flushes dirt or minute particles from the skin and removes them. With daily body cleansing and regular change of clothes, granulomas usually recede. Often, the number of neoplasms decreases at the same time. If complications occur, a prolongation of the healing process is to be expected. In addition, papules may form. In severe cases, scars remain on the skin, which represent a cosmetic blemish.
Prevention
As with many other skin conditions, prevention of granulomas can consist of practicing basic personal hygiene. In addition, a general healthy lifestyle with plenty of exercise and sports, as well as 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 first priority here.
Aftercare
In the case of a granuloma, the options for aftercare are few and far between. In this case, the affected person is primarily dependent on direct and correct treatment by a medical professional in order to prevent complaints 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 granuloma are dependent on taking medication and using creams and ointments. Regular intake is to be ensured, and interactions must also be taken into account. In cases of doubt, a doctor should always be consulted directly. Furthermore, the creams should also be regularly instructed to relieve the discomfort. Since a granuloma can also have a very negative effect on the aesthetics of the affected person and reduce them. Patients are therefore often dependent on psychological support from friends and family to counteract these complaints. Contact with other sufferers can also be very useful in this regard. This often results in the exchange of information, which can make everyday life easier.
What you can do yourself
Even though granulomas are generally considered not to require treatment, those affected often see it differently. Depending on the localization, the skin growths show up as very disturbing. There is itching, dry skin areas and even sores, and a reduction in the quality of life. This can have a negative effect on the psyche of the person affected. In addition, granulomas are usually visually conspicuous and can thus become another reason for depressive behavior. In this case, seeing a psychotherapist is strongly advised. Psychological care offers the sufferer the possibility to express himself free of shame, without the direct environment finding out about the weakened self-confidence. The affected person can also try to alleviate the accompanying symptoms of the skin nodule by self-help. If cold compresses do not inhibit the itching and the thought goes in the direction of itch-relieving ointments and creams, this should be discussed in advance with the attending physician. As soon as it comes to applying or taking medical products, 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 areas in order to avoid inflammation. Depending on the size and location of the granuloma, corn plasters or similar can be used to cushion the area. Especially in chafing areas, this can provide relief.