Treatment of granuloma in a child. Treatment of granuloma annulare in children. Diagnosis and treatment of granuloma annulare

Granuloma annulare (lat. Granuloma annulare) is a chronic skin disease that most often appears in children. It is not contagious and is mild, however, it is sometimes very difficult to diagnose. There are cases when a person with granuloma annulare is treated for a long time for skin diseases with similar symptoms to no avail.

Granuloma annulare - causes and risk factors

The causes of granuloma annulare are not known, however, it is most often believed that the underlying cause of the disease may be an immune response to an unknown antigen. In turn, the list of risk factors includes bruises, insect bites, tattoos, the Mantoux test, antiviral vaccinations, viral and bacterial infections, exposure to ultraviolet radiation, and concomitant immunological and oncological diseases. Some believe that diabetes mellitus contributes to the development of granuloma annulare, but its connection with this skin disease has not been conclusively confirmed.

There are the following clinical forms of granuloma annulare:

• Subcutaneous
• Localized
• Disseminated
• Perforating.

Localized form of the disease occurs in children in 90% of cases and only in 10% in adults. It appears as single lesions on the hands, feet, legs, as well as on the bends of the limbs of the arms and legs. In this case, papular rashes of dense consistency are formed. They may appear crescent-shaped or ring-shaped, but the middle or center of the lesion appears intact.

The lesions range in size from two to five centimeters or more, some of them have jagged edges, and are lilac-pink in color. Papular nodules lie quite densely in the thickness of the skin. There are cases when rings form in the area of ​​a large joint or other area of ​​skin.

Subcutaneous granuloma It occurs mainly in children under six years of age, most often located on the scalp and fingers, and can affect the upper eyelid area.

In rare cases perforating form Children, adolescents and young people are susceptible to the disease. In this case, the papular rash has a plug in the center filled with contents in the form of jelly, which is periodically released, forming crusts pressed into the middle of the papule. After the scab falls off, a hyperpigmented scar remains.
Disseminated form of granuloma It is rare in children.

Diagnosis of granuloma annulare

Diagnosis is usually made based on symptoms. In this case, granuloma annulare should be distinguished from periarticular nodules (the location of the nodules is deeper than in the case of granulomas), annular sarcoidosis (characterized by violet-brown nodules and often occurs against the background of changes in other organs) and lichen planus annulare (characterized by flatter thickenings and other positioning of affected areas). Unfortunately, sometimes the symptoms are ambiguous, which is an indication for histological examination, that is, a biopsy.

Treatment

In case of local changes, a good effect is achieved by using local therapy. General treatment is used in cases where the lesions are scattered or in the absence of response to local treatment. In children, a spontaneous decrease in changes is very often observed.

As mentioned above, in case of individual changes, it is sufficient to apply local treatment (corticosteroids in occlusive dressings). Improvement was also observed with 0.1% tacrolimus or 1% pimecrolimus.
General treatment includes corticosteroids, dapsone, or antimalarial drugs. In severe cases, cyclosporine A or fumaric acid esters can be used.

When treating annular granulomas, you can also use freezing changes with liquid nitrogen or ethyl chloride. In the diffuse form of the disease, improvements can be achieved using photochemotherapy.

Granuloma annulare is one of the complex diseases, the cause of which has not been fully elucidated. This is a chronic skin disease characterized by the appearance of small, dense, raised nodules that form a ring with normal or slightly sunken skin in the center.

Causes and symptoms of granuloma annulare

Doctors believe that infections influence the development of the disease. It is assumed that this may be a reaction of the immune system, accompanied by a violation of cellular immunity and a delayed allergic reaction. Most often, granuloma annulare develops against the background of:

• Genetic predisposition;
• Sarcoidosis;
• Carrying out tuberculin tests;
• Tuberculosis;
• Rheumatism;
• Injuries;
• Bites from ticks and other insects;
• Sunburn;
• Autoimmune thyroiditis;
• Diabetes mellitus;
• Long-term use of vitamin D.

Quite often, pathology develops at the site of scars and tattoos, after shingles and warts. The disease is also often associated with impaired carbohydrate metabolism.

Granuloma annulare in children and adults appears as yellowish nodules in one or several rings. Most often they form on the legs, feet, hands and fingers and usually do not cause itching or pain.

Types of granuloma annulare

There are two forms of granuloma annulare. In the typical course of the disease, the skin of the knees, hands, and feet (back side) is affected. Sometimes papules appear on the buttocks, neck and forearm area. In diabetics and older people, they can be localized on the upper and lower extremities and torso.

The atypical form of granuloma annulare can be divided into:

• Subcutaneous, in which many nodes appear in the forearms, elbows, fingers, back of the hands, and sometimes on the upper eyelids and scalp. The subcutaneous form of granuloma annulare develops in children under 6 years of age, more often in girls;
• Disseminated, usually manifesting in adults. This form corresponds to multiple, scattered rashes, and the papules are usually flesh-colored or purple in color. Treatment for this form of granuloma annulare is usually long-term;
• Perforating, occurring in most cases after skin injuries. As a rule, this form is characterized by plugs in the center of the ring, and from time to time a gelatin-like substance is released from the nodules. After healing, the skin becomes crusty with a small indentation in the center of the lesion, after which scars appear. In the future, papules may turn into large plaques.

Diagnosis and treatment of granuloma annulare

Clinical manifestations of the disease are easily recognized. The diagnosis is usually confirmed by a dermatologist with a visual examination. In some cases, histological examination of biological material is required.

Before the examination, you should not steam, pick, rub with a brush or hard washcloth, or try to squeeze out the rash. Also, you cannot “dry” them under the sun’s rays and irradiate them with a UHF lamp.

In many cases, treatment for granuloma annulare is not required and the disease goes away on its own. To speed up the disappearance of the rash, external agents are often used - corticosteroids, over which waterproof bandages are applied.

Treatment of isolated foci of pathology is carried out using hydrocortisone ointment with ichthyol and phonophoresis. Therapy is also carried out that helps normalize the immune system and inhibits the process of antibody formation. Against the background of external treatment and measures that increase immunity, it is important to treat the disease against which the granuloma developed (diabetes mellitus, tuberculosis).

Other methods of treating granuloma annulare include:

• The use of ascorbic acid, tocopherol acetate, B vitamins, products containing iron;
• Injection of papules with triamcenolone acetonide;
• Use of dapsone, niacinamide, hydroxyloroquine and isotretinoin;
• Using chloroethyl to irrigate the affected areas, after which they become covered with “frost”;
• The use of carbonic acid or liquid nitrogen;
• PUVA therapy is a method that involves irradiating the skin with long-wave ultraviolet radiation and the use of psoralens.

To prevent a secondary infection, you can treat the affected areas with tincture of iodine 2-3 times a day. If the affected area is located on the legs, it is not recommended to walk barefoot on open ground.

Treatment with folk remedies for granuloma annulare is considered ineffective, since the disease is closely related to the immune system. Therefore, external therapy in the form of rubdowns, lotions or baths should not be carried out, but it is necessary to strengthen the immune system. For this it is recommended:

• Take echinacea in pill form or as a setup;
• Drink restorative herbal teas and natural juices;
• To live an active lifestyle.

Typically, granuloma annulare is cured within 1.5-2 years in 60-80% of cases, and relapses that occur usually go away faster than the primary rash. The prognosis of the disease improves following the principles of a healthy lifestyle.

How to treat granuloma annulare with folk remedies

Granuloma annulare. Treatment of granuloma annulare

Granuloma anulare is a recurrent chronic dermatosis, the causes of which are not yet well understood. It is characterized by the development of numerous dense nodules on the skin, which are grouped in the shape of rings.

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Granuloma annulare - mechanism and causes of disease development

● Granuloma annulare in children is most often caused by even minor violations of the integrity of the skin: abrasions, a scratch caused by a cat, small wounds. Especially when they were poorly processed or not processed at all.

The same thing happens with inflammation of acne during puberty in adolescents. There are other known ways of transmitting infectious agents (bacteria, worms) due to violation of hygienic requirements when eating food or dental treatment.

● There are known cases of the appearance of granuloma annulare as a result of contact with exposed parts of the body with damaged skin of foreign bodies or toxic substances - paints and chemical dyes, talc (when putting on medical gloves), zirconium along with deodorant, paraffin, silicone (in persons with joint prostheses) .

Among other things, granuloma annulare can occur in adult patients if they have a history of systemic diseases, for example, rheumatoid arthritis, lupus erythematosus, sarcoidosis, tuberculosis, diabetes mellitus, malignant tumors, etc.

● From this we can conclude that granulomatous diseases unite a large group of dermatoses, in which the development of granulomas is accompanied by a subsequent immune response of the body.

● The disease manifests itself by appearing on the skin in any part of the body, most often on the lower extremities, nodules or plaques - single or multiple. In the latter case, we are dealing with granulomatosis.

Immune cells that come to the rescue are grouped around these lesions and lead to the development of inflammatory infiltrates. However, in general, neoplasms do not cause much concern for patients, since most often there is no pain or itching.

● How does a person who has something formed on his body react? At first he doesn’t pay attention to the granuloma annulare at all - they appeared and appeared. Unrest begins when the rashes increase in size more and more, do not go away for a long time and occupy new areas of the body.

By the way, granuloma annulare can remain on the skin from several months to several years, either disappearing for a while, or appearing with renewed vigor, although without significant objective sensations.

● If everything is resolved successfully, pigment spots remain on the body, which become invisible over time. Undoubtedly, it is in no way possible to leave a disease to the mercy of fate, or self-medicate it, which will lead to blurring the picture of the disease.

It is best to contact your local dermatologist in a timely manner, who will prescribe comprehensive treatment and additional examination to determine the true cause of the granuloma.

● Usually a dermatologist prescribes hormonal ointments in such cases - triderm, celestoderm, dermovate, which are usually applied to the skin under a bandage. The ointment is selected by the doctor, because these drugs are strong and should be used strictly as prescribed, in certain courses.

As practice has shown, sometimes it is necessary to prescribe certain antimalarial drugs, which are also effective for granulomatosis.

● When annular granulomas are difficult to treat and they have a pronounced cosmetic defect, they are removed using special methods in a hospital setting. In this case, in order to determine the nature of the dermatosis, a mandatory histological examination is carried out.

Of course, when the rash is a consequence of any systemic diseases, it is very important to carry out comprehensive treatment to improve the health of the body and heal the underlying disease, which will help get rid of granulomas.

● Before an examination by a doctor, you should not pick, steam, rub with a brush or hard washcloth, or try to squeeze out the rash. It is also not recommended to “dry” granulomas by sitting in the sun.

Irradiate with a UHF lamp (blue) or other similar devices, which many families have now begun to purchase to sanitize the air environment. Physiotherapeutic treatment of granulomas at home will also not be beneficial.

● To prevent secondary infection, you can treat the affected areas with iodine tincture as quickly as possible, and then lubricate them with brilliant green two to three times a day.

Wear socks when gardening or gardening to prevent germs or bacteria from entering through small cracks on the soles of your feet.

To prevent a visit to the dental office from developing granuloma annulare, you need to rinse your mouth after eating and before going to bed with an infusion of oak bark, chamomile or sage.

● In all other cases of the development of granulomas, any rubbing, lotions, baths or other water procedures are not effective. Due to the fact that the disease is closely related to the body’s immune response to rashes, it is recommended to strengthen the immune system.

To do this, take Echinacea tablets: for children over 12 years of age and adults – one tablet three to four times a day. Keep the tablet in your mouth until completely dissolved. The course is thirty days, you should not take the drug for more than a month.

● To prepare an infusion for rinsing the mouth, take 2-3 tablespoons of raw materials (see above), pour half a liter of boiling water and leave for 30-40 minutes, filter. As for the oak bark infusion, leave it in a thermos from evening until morning.

● How to boost immunity with folk remedies:

- mix five tablespoons of table rose hips with one tablespoon of chopped elecampane root, pour a liter of boiling water over the mixture and place on low heat; after 15-20 minutes, remove and leave for one hour; Use the decoction as an additional infusion for any tea, adding a little boiling water;

- mix half a glass of radish juice and carrot juice, add one tablespoon each of May honey and lemon juice; drink 3-4 times a day a tablespoon before meals.

- granuloma annulare is cured in 60-80% of cases within one and a half or two years; this should be kept in mind in order to be patient for successful healing of the disease; relapses occur, but, fortunately, they resolve much faster than primary rashes;

— lead a healthy and fairly active lifestyle; From childhood, engage in sports, swimming, and strengthen your body.

Be healthy, friends, God bless you.

The article uses materials from Ph.D. I. G. Shulgina

In conclusion, I suggest you watch a video in which the doctor tells how a girl was cured of granuloma annulare after taking Transfer Factor.

Granuloma annulare is a disease manifested by nodules or papules arranged in the shape of a ring. The disease is common among various age groups, is more typical for women and children, and is relatively benign. More often it occurs in combination with other skin lesions, infectious diseases or systemic disorders: acute rheumatic fever, chronic inflammation of the upper respiratory tract, diabetes mellitus, tuberculosis, skin sarcoidosis and others.

Granuloma annulare types

There are several main forms of granuloma annulare, depending on the prevalence and location of the pathological focus in the skin layers:

1. localized granuloma annulare is a cluster of dense nodules on the surface of the skin;
2. disseminated, or widespread, form is a multitude of plaques on the entire surface of the body or part of it;
3. papular form - these are separately located single lesions;
4. deep, or subcutaneous, is atypical, and resembles rheumatoid nodules in consistency and appearance;
5. the perforating form is a lesion penetrating into the deep layers of the skin.

According to the morphological structure, papules in granuloma annulare are divided into frontal and interstitial. In the first type, lymphocytes and plasma cells accumulate in the papillary layer of the dermis along with proteins in the form of a palisade or fence. With the second type of granulomas, pathological accumulations are observed between the cells of the dermis in no particular order.

Granuloma annulare causes

Granuloma annulare is a disease that belongs to the idiopathic group. This means that the nature of the disease is not fully understood. The probable cause of nodules is autoimmune inflammation in the skin layers against the background of a viral or bacterial infection. The multifactorial nature of the pathology is confirmed by the discovery in patients of chronic inflammatory processes in the form of tuberculosis infection, sarcoidosis and acute rheumatic fever and the connection of the disease with autoimmune processes of the thyroid gland and diabetes mellitus. The onset of the disease may be preceded by infection with Epstein-Barr viruses, herpes simplex, chickenpox or human immunodeficiency virus. The course of HIV infection is severe and widespread.

The association of granuloma annulare with long-term use of certain medications (vitamin D) and vaccination has been confirmed. There are known cases of rashes appearing against the background of BCG and the Mantoux test. The main component of pathogenesis is considered to be delayed hypersensitivity, or type IV, because it is characterized by the development of an allergic reaction within a few days after exposure to the allergen and a sluggish course.

Granuloma annulare symptoms and manifestations

The clinical picture of the pathology varies depending on the type and extent of the process. For localized form characterized by the accumulation in typical places of small pinkish nodules in the shape of a ring or semicircle. In 60% of cases, the skin on the back of the hands or the skin on the forearms is affected, and in 20%, the back of the foot or lower leg. Less commonly, granuloma annulare can be seen around the eyes or on the scalp. The rash is rarely accompanied by itching or other unpleasant sensations and goes away without a trace. A new one may appear in place of a resolved granuloma. At papular form plaques of the same size and outline are located not in a group, but in isolation.

Deep or subcutaneous granuloma annulare typical mainly for children. The disease manifests itself in the form of painless nodules in the deep layers of the skin of the extremities, on the elbows, fingers, and scalp. You can find granuloma annulare in children on the skin around the eyes. On the extremities, the nodules do not adhere to the surrounding tissues and are mobile; on the scalp they merge with the periosteum. Recurrence of rashes after surgical treatment is possible.

For disseminated form The ring-shaped arrangement of papules is not typical; the pathology manifests itself mainly after 50 years. The lesions are localized on the hands and feet and vary in shape and color (from pinkish to shades of purple). This form is difficult to treat compared to localized variants and often recurs.

Perforating granuloma annulare is a consequence of traumatic exposure and is typical for children or young people. The lesion is located on the hands or fingers and resembles a funnel-shaped depression with a jelly-like plug in the center. As the lesion heals, it turns into a scar. The perforated form may be common. In this case, the papules transform into large plaques.

How to make a diagnosis?

When making a diagnosis, they focus primarily on typical skin manifestations. In rare cases, it may be necessary to take biopsies from the lesion. If the infectious nature of the granuloma is suspected, consultation with a specialist in the field or a therapist is necessary. The occurrence of the disease against the background of diabetes mellitus requires the help of an endocrinologist to control glucose levels and prevent the progression of the process. In special cases, it is necessary to test blood and skin biopsies for immune complexes to exclude an autoimmune process.

Treatment

When treating the disease, it is necessary to take into account the tendency of the process to spontaneous regression within 2 years. Recurrent papules may also disappear on their own without external intervention. As necessary, glucose levels are corrected and concomitant infectious pathologies are treated. Disseminated forms require systemic use of glucocorticosteroid drugs. Treatment with hormonal agents or non-steroidal anti-inflammatory drugs is carried out if the lesions cause discomfort. Surgical removal of subcutaneous nodes is possible in various ways.

Treatment with folk remedies

Granuloma annulare should be treated with folk remedies very carefully. This disease is accompanied by disorders of the immune system, so you need to start by strengthening the body's defenses. A decoction of rose hips and elecampane root is perfect as an effective means of strengthening the immune system. To prepare it, you need five tablespoons of rose hips and a tablespoon of elecampane, pour a liter of boiling water and cook for about 15 minutes over low heat. Then let it brew for an hour. The decoction is used as an additive to tea or as a stand-alone drink.

You can also strengthen your immune defense with the help of Echinacea tablets: you need to take a tablet 3-4 times a day for a month. The course can be repeated periodically, but no more than twice a year.

Prognosis and consequences of the disease

Granuloma annulare is not dangerous to life or ability to work. In most cases, it disappears spontaneously and does not require special treatment; rarely, small scars remain after papules. To reduce the likelihood of relapse of the disease, it is necessary to follow the rules of a healthy lifestyle and strengthen the immune system.