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  Granuloma Annulare  
 
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Granuloma annulare (GA) is a long-term (chronic) skin disease consisting of a rash with reddish bumps arranged in a circle or ring. GA most often affects children and young adults. It is slightly more common in girls. The condition is usually seen in otherwise healthy people. Occasionally, it may be associated with diabetes or thyroid disease. Its cause is unknown. GA is usually asymptomatic, but the rash may be slightly itchy. Patients usually notice a ring of small, firm bumps (papules) over the backs of the forearms, hands or feet. Occasionally, multiple rings may be found. Rarely, GA may appear as a firm nodule under the skin of the arms or legs.

Your doctor may consider the diagnosis of fungal infection when looking at your skin. A skin scraping and KOH test can be used to tell the difference between the two conditions. A skin biopsy may also be necessary to confirm the diagnosis of GA.

Because GA is usually asymptomatic, treatment may not be necessary except for cosmetic reasons. Strong topical steroid creams or ointments are sometimes used to speed the disappearance of the lesions. Injections of steroids directly into the rings may also be effective. Some physicians may choose to freeze the lesions with liquid nitrogen. In severe cases, ultraviolet light therapy (PUVA) or oral medications may be needed.

Most lesions of GA disappear with no treatment within two years. Sometimes, however, the rings can remain for many years. The appearance of new rings years later is not uncommon.
 

 
 

Recommendations for Granuloma Annulare:
 
 
Chemical  Fumaric Acid
 A 40-year old Caucasian woman with a 25-year history of recalcitrant disseminated GA (DGA) was treated with fumaric acid esters in tablet form using two formulations differing in strength (low strength tablets: 30 mg dimethylfumarate, 67 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt; high strength tablets: 120 mg dimethylfumarate, 87 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt). After three-months of therapy, an almost complete clearance of skin lesions was achieved. With the exception of temporary lymphopenia, no adverse effects were observed. The patient remained in remission during a six-month follow up period. The use of fumaric acid esters is a potentially beneficial therapeutic option for patients with recalcitrant DGA. However controlled trials are necessary to fully explore the efficacy, optimal dosage, and safety of fumeric acid in DGA. [BMC Dermatology 2002 2:5]
 
 


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GLOSSARY

Asymptomatic:  Not showing symptoms.

Biopsy:  Excision of tissue from a living being for diagnosis.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Steroid:  Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.

Thyroid:  Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.

Topical:  Most commonly 'topical application': Administration to the skin.