Ring-shaped granuloma in children: causes, diagnosis, treatment

Annular granuloma is a benign chronic and recurrent progressive skin disease. Lesions are characterized by a ring-shaped form of nodules on the background of the destruction of collagen fibers and granulomatous inflammatory reactions. They can occur regardless of gender and age.

A granuloma is considered an attempt by the body to limit or isolate an infectious, inflammatory process, a foreign body, possibly through a nonspecific immunological reaction.

Pathological process can last several months, or even several years. It begins presumably with a lymphocytic immune response, leading to activation of macrophages and connective tissue degradation mediated cytokines, which leads to the formation of a lenticular papule, which has a clearly expressed somewhat atrophic depression in the central part, which grows with a remitting progression, then accelerating, then slowing down in growth.

The annular granuloma itself is a plaque of 5 sq. Cm or more in size, somewhat elevated above the surface of the healthy skin and only in the center aligned with the tone of it. The skin easily gathers into folds, but around the sunken area there is a dense, waxy shiny burgundy or slightly pinkish ring or half moon, which is a not very wide cushion (up to 2-3 mm). It may consist of individual grayish papules with pinkish corollas, not welded to the underlying skin layers.

The rings are sharply contoured, with the inner edges going down into the sunken central areas. Due to palpation in the epithelium, a neoplasm similar to a tumor can be found, which gradually passes into the surrounding integument. In its structure, it has epithelioid cells and fibroblasts, which on the periphery are surrounded mainly by lymphoid cells, and also less frequently - plasma and mast cells. The location of the round-cell infiltrate - in the main course of the vessels, is accompanied by the formation of powerful plexuses from argentophilic fibers. Separation of nodes occurs due to trabeculae and collagen fibers. The central parts are pronounced foci. necrosis and the destruction of elastic fibers. The walls of the vessels gradually thicken, proliferation of the endothelium is observed, which can lead to blockage of individual vessels.

Annular granulomas can be located in the deep layers of the skin itself and even in the subcutaneous tissue. They are felt as a peculiar kind of nodules resembling dense peas or beans, which do not change the structure of the skin on the surface.


Depending on the location and other features of the granuloma are:

  • Subcutaneous - more common in children, are located on the hairy area of ​​the head, near the eyes and on the extremities.
  • Plaque - usually occur in women, they are characterized by the presence of erythematous, red-brown or purple plaques without annular rims.
  • Localized and disseminated - as a result of pathology, a single lesion can form or spread to other parts of the body.
  • Perforation - this type of dermatosis is quite rare and is characterized by the presence of traffic jams in the center of the formations and gelatin-like secretions, as well as the formation of larger plaques, crusts and further scarring.
  • Interstitial form (with mucin infiltrate between collagen fibers) and front garden form (in the center there is collagen surrounded by histiocytes).

At the moment, the origin of the granuloma is ring-shaped or otherwise - anular is considered unexplained. It is believed that the basis of the granulomatous process may be allergic reactions or changes in tissue reactivity caused by by stress, genetic factors or the course of such chronic diseases as:

Disease development may be associated with connective tissue diseases, diabetes mellitus and disorders of carbohydrate metabolism.

Pathology is more susceptible to scar tissue, bites of animals and insects, and places of tattoos.

Annular granulomas are usually localized:

  • on the back of the hands and feet,
  • on the fingers,
  • on the neck,
  • less often - on the buttocks and legs, on the elbows and forearms.

The course of the disease is not accompanied by subjective pain or discomfort.

Analyzes and diagnostics

Initially, it is necessary to study the clinical manifestations of the disease and the collection of anamnesis data.
Histological studies of skin biopsy help confirm the diagnosis of annular granuloma. Differential diagnosis is carried out with erythematosus, lichen planus and Beck's sarcoid.

Treatment of annular granuloma

Treatment can be carried out using X-rays, photoactive substances, arsenic, ointments with a high content of topical steroids (for example, Psoriderm). In addition, the patient may need:

  • correction of carbohydrate metabolism,
  • therapy with drugs that improve microcirculation,
  • multivitamin course.

Treatment of annular granuloma in children is the most benign. Any medication should be used with caution and only after consultation with the family doctor. May be recommended Interferon or others immunomodulators.

The role of immunity

It is violations in the work of cellular immunity that play a major role in the development of the described disease. If a ring-shaped granuloma has appeared in children, it means that the immune system has failed due to infection. Dermatosis is only a reflection of problems in the body. If the patient suffers from diabetes, then annular granuloma affects large areas of the skin. In children, this form is extremely rare.


This is the most common form of ring-shaped granuloma in children. In adults, this form of the disease is much less common. The localized form is almost invisible on the skin, rarely there are more than two foci of lesions. Basically, the granuloma selects for a rash of the forearm and the back of the hands. In rare cases, foci may form over large joints, in the abdomen, back, feet, eyelids, head, buttocks. There are no discomfort and discomfort (except for cosmetic) ring-shaped granuloma of the localized form does not cause. This type of dermatosis is capable of self-healing, leaving no trace of its presence on the skin.

Other ways

Hydrocortisone emulsion can be used for chipping granulomas. But for children, this type of treatment is not recommended, as it can cause temporary atrophy of the skin.

There are other methods of treatment, but they are all controversial. The fact is that one way can help one person, it will not affect others. Scarification is sometimes used, that is, the method of surface incisions. It has happened that the granuloma annular completely passed after the biopsy procedure - the collection of surface tissues from the affected area for examination.

In the presence of chronic diseases, treatment is applied to correct them. Vitamin therapy will be useful for children, vitamins of group B, E, C are especially useful. Physiotherapy and the introduction of medicinal substances with the help of ultrasound are prescribed to many people.

It is always necessary when the ring-shaped granuloma in children is treated. Komarovsky - doctor, answers all questions of interest on the course of the disease in his forum. Also, parents who are struggling with granuloma or other diseases answer questions.

Types of granulomas in children

As a rule, granuloma is a disease of the skin covering of a chronic nature. Its most common type is annular granuloma, which is often seen in children in the age range from three to six years. Ring-shaped granuloma - a disease of an idiopathic chronic benign character with the presence of lesions in the form of papules and nodules, forming in the process of growth of a ring around atrophic or normal skin.

In 90% of cases of diseases, a localized type of rash is observed - the presence of a single lesion. Papules have a color identical to the skin of the child. The size of the lesion (the ring) is up to 50 mm. There are cases when another ring is present in the middle of one ring. There is a subcutaneous type of annular granuloma. Characterized by the location of granulomas in the upper layers of the skin in the elbows, knees, fingers, forearm or on the head in the hair. There have been rare cases of granulomas in the eyelids.

Another type of disease is a perforating type of annular granuloma. It manifests itself in isolated cases. Her papules have cork formations, from which a substance constantly resembles that resembles gelatin in appearance. There is an increase in papules in size. The rarest type of annular granuloma is disseminated when rashes appear in the trunk and distal areas of the extremities.

A rare form of granuloma is bone eosinophilic granuloma. It is characterized by the formation of granulomas with a content of eosinophilic leukocytes in the bone marrow. This disease is known as Taratinov disease. This granuloma can occur mainly in children up to seven years, in rare cases in adolescents. The main symptom of bone granuloma may be a single (multiple) isolated lesion in the bones. Often there is damage to the bones of the skull, ribs, femurs, pelvic bones, vertebrae.

Causes of granulomas in children

At this point in time, specialists cannot unambiguously determine the true cause of the occurrence of a granuloma. Some scientists believe the cause of the rash is the presence of such a disease as diabetes. Other experts cite as a reason for the disturbed metabolism of carbohydrates in the body, excessive consumption of refined products. It is believed that mechanical skin injury can also be a source of disease. The origins of the disease are not completely clear, so it’s hard to understand what to fear.

Diagnosis of granuloma

To determine the presence of the disease is possible only through the study of histology. Only this diagnostic method allows you to recognize the presence of elastin fiber destruction, allows you to see changes in the blood vessels of the dermis located in the middle part of it, notice the slightest formation of necrobiosis in the connective tissues and identify many other factors that are signals about the presence of granulomas in the body.

Granuloma of the bones is extremely difficult to diagnose due to the lack of clear symptoms and the diversity of the X-ray picture. Therefore, cases of erroneous conclusions are not rare. A doctor can make a clear diagnosis, based on several factors - pain in the area of ​​the bone, X-rays, microscopic examination of a sample of material obtained by casting an operation, biopsy or puncture. Moreover, the latter method is fundamental and decisive for the correct treatment.

Treatment of granulomas in children

In the treatment of annular granulomas, a combination of freezing lesions with occlusive dressings soaked in glucocorticoid ointments is usually used. Fortifying treatment with taking vitamins of group C, E, B1, B2 is also recommended. In some cases, a positive result is given by subcutaneous obkalyvanie affected foci with hydrocortisone suspension. However, possible atrophy of the skin when using this method should be considered.

Bone granuloma requires surgery or radiotherapy. In cases of a single lesion of the bone, recovery occurs after the operation, and the bone defect, after the elimination of the granuloma, is filled independently. Full recovery can be ascertained after a year. If large areas of bone have been damaged, then after cleaning, it will be necessary to fill the void with a special gomostrugy or to transplant a healthy bone. In the case of multiple lesions of the bone granuloma, radiotherapy is performed.

There is an opinion and cases have been recorded where the granuloma disappeared spontaneously without any treatment. Most likely this is due to not fully clarified the reasons for its occurrence. But it is better not to experiment, if there are ring-shaped rashes on your child’s body or he complains of bone pain, immediately contact a doctor who will diagnose and select the right treatment for your child.

Expert Editor: Pavel Alexandrovich Mochalov | D.M.N. general practitioner

Education: Moscow Medical Institute. I. M. Sechenov, specialty - “Medicine” in 1991, in 1993 “Occupational diseases”, in 1996 “Therapy”.

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Granuloma flux

Flux is called purulent inflammation, the focus of which is located under the periosteum of the jaw. Nowadays in medicine more often a more accurate term is used - odontogenic periostitis. This pathology may well be a complication of a tooth granuloma that was not cured in time. Flux is a much more serious and dangerous disease than just an inflamed cyst or granuloma. This is due to the deep location of the outbreak and the high risk of the spread of a purulent process.

The main signs and symptoms of flux are:

  • constant pain
  • marked swelling of the gums (usually under several teeth),
  • breakthrough of pus in the oral cavity,
  • cheek swelling,
  • enlarged lymph nodes located near the nidus,
  • temperature rise,
  • headache and weakness.
Flux treatment for granuloma is only surgical. The doctor makes an incision and empties the cavity from pus. After that, a course of antibiotics is needed to prevent re-accumulation of pus.

What to do if a granuloma has burst?

The granuloma, unlike a cyst, does not have an internal cavity filled with fluid. This is a bundle of dense tissue. As a result, the granuloma simply can not burst. However, some types of granulomas can grow, become inflamed, or gradually turn into ulcers (ulcerate). Patients with a feeling that the granuloma "burst."

The main sign that the granuloma "burst" is the leakage of fluid from the inflammatory focus. This is usually pus, which is formed due to infection of the affected area. Granuloma itself does not emit a liquid, but can be melted by the same purulent process. The most prominent example is the inflammation of the tooth granuloma. From the location of the granuloma gradually begins to leak pus or blood, which fall into the oral cavity. At the same time, the patient develops an unpleasant taste in the mouth, bad breath, bleeding of the gums, and pains intensify.

If the patient has a feeling that the granuloma has burst, you need to act as follows:

  • If there are signs of suppuration of the tooth granuloma, you need to gently brush your teeth and rinse your mouth with boiled water and disinfectant solutions.
  • It is not recommended to eat spicy, salty or too hard food, so as not to worsen the gum condition.
  • You can drink painkillers or anti-inflammatory drugs.
  • You need to contact your dentist as soon as possible. Antibiotics and more effective rinses are usually prescribed. Surgery may also be required.
  • Granulomas on the skin or in the subcutaneous tissue "burst" much less. If the abscess on the site of the granuloma opened, you need to gently rinse it with warm boiled water.
  • On the resulting wound impose a dry clean bandage.
  • It is necessary to consult a specialist (a surgeon or dermatologist), which will determine the nature of the lesion and prescribe the necessary treatment.
Granulomas that form in internal organs can destroy surrounding tissues, dissolve or turn into cysts. Sometimes this is accompanied by the appearance of various symptoms, the deterioration of the patient. However, the patient himself does not notice that his granuloma has “burst”. In any case, if any complications are suspected, it is necessary to notify the attending physician as soon as possible.

A fistula is a pathological formation, a hole that connects a hollow organ or any cavity with another cavity or environment (external fistula). In principle, no fistula is formed in granulomas, since there are no cavities in the granuloma. But some formations as a result of infection or decay can form ulcers, and then cysts or pathological cavities. They also can have fistulas. Thus, such a complication as a fistula is more often formed after the collapse of the granuloma.

In principle, symptoms depend on the location of the fistula and the pathological process. If we are talking about an infection, there is a threat of its spread to other organs and tissues. Otherwise, there is usually a leakage of pus, blood or extracellular fluid that accumulates in the cavity. Fistulas are a surgical problem. Due to the threat of secondary infection when they appear, it is imperative to consult a doctor and eliminate this formation surgically.

Granuloma recurrence

Relapse is called the re-development of the disease associated with improper or insufficiently effective treatment. Re-infection (with infectious diseasesa) recurrence is not considered. If we are talking about a granuloma, then it can be considered a relapse to recur after the removal or resorption of a defect detected for the first time.

Whether the granuloma will recur or not depends entirely on the causes of the problem and the quality of the treatment. Granuloma recurrence is, in principle, possible in many infectious or autoimmune processes. Granulomas caused by foreign bodies or injuries do not recur after the cause of their formation has been removed.

The recurrence of the granuloma is theoretically possible in the following pathologies:

  • Sarcoidosis. Sarcoidosis is an inflammatory process caused by autoimmune mechanisms. Against the background of intensive treatment, granulomas often disappear, but complete recovery is usually not possible. Over time, the granulomas reappear.
  • Tuberculosis. Tuberculous granulomas are formed due to tissue destruction (usually in the lungs) and their isolation by special cells. The course of treatment involves prolonged intensive antibiotic therapy. This is necessary because the causative agent of tuberculosis is practically not sensitive to most antibacterial drugs. After treatment, granulomas may disappear or calcify (cover with a dense calcium capsule). In both cases, doctors can talk about recovery. Unfortunately, many patients have relapses. Bacteria of tuberculosis that are resistant to many anti-tuberculosis antibiotics are very common.
  • Syphilis. Syphilitic gummas usually appear in the late stages of the disease and may be located in various organs and tissues. As a rule, new granulomas appear in a period of weakened immunity. Over time, most of the gum is healed, leaving scars and scars. However, if the pathogen is not eradicated (by the right course of antibiotic therapy), the granulomas will reappear. The immediate cause of their formation in syphilis is repeated reproduction of treponema (causative agent) and their entry into the tissue with blood flow.
  • Fungal infections. Fungal infections often cause granulomas in the lung tissue. Antifungal drugs used for treatment kill a significant amount of fungi, so granulomas can dissolve. However, this does not always mean complete recovery. The infection itself may remain in the tissues, and within a few weeks after the early interruption of treatment, granulomas may recur. Especially often this occurs in persons with severely weakened immunity.
  • Histiocytosis. Histiocytosis is characterized by the appearance of numerous granulomas in various organs and tissues. The disease is difficult to treat, and the disappearance of granulomas is usually temporary.
  • Rheumatoid arthritis. The Aschoff-Talalaev granulomas, which are formed in this joint pathology, are the result of an autoimmune inflammatory process. After an effective course of treatment, they may disappear. However, rheumatoid arthritis is a chronic pathology, and it is completely rarely possible to cure it. Most often, after some time, re-exacerbation occurs, and granulomas reappear. True, they may appear in other places (in the area of ​​other joints).

What is the outcome and consequences of granulomas?

In principle, there are two different outcomes of granulomas. In the first case, they dissolve and disappear on their own, without leaving any traces. This recovery option is possible with some infections and autoimmune processes. For example, the ring-shaped granuloma of the skin in most cases passes without a trace (sometimes even without special treatment). With the right treatment, granulomas can be reduced in sarcoidosis.

The second option is the disappearance of the granuloma with the formation of a scar or scar. At the same time, such a scar can be located both on the skin surface and in the thickness of the tissues, and even inside the organs. The mechanism of scar formation is quite simple. Some granulomas in the process of development destroy normal tissue. To compensate for the defect, the body produces connective tissue fibers, which form the scar. Rough scars that interfere with the work of internal organs and severely spoil the appearance of a person are formed after the disappearance of syphilitic granulomas. There is also a third option, which is quite rare. This is the calcification of the granuloma. Tissues accumulate large amounts of calcium and are calcified (like a shell or pebble). Such foci remain in patients until the end of life (if they are not surgically removed). A similar mechanism is sometimes found in patients with pulmonary tuberculosis. Infection is conquered, but Gon’s focus remains in the lungs (calcification), which will be visible on the x-ray until the end of life.

In general, after recovery in patients with granulomas, the following effects are possible:

  • Cosmetic defects. May occur if the patient had superficial granulomas due to syphilis, chlamydial infection (inguinal granuloma) after injuries.
  • Lack of organs. Granulomas in the lungs, for example, can cause extensive and irreversible damage to the tissues. Then the patient will suffer from respiratory failure until the end of life. Liver failure or kidney failure (depending on the location of the granulomas).
  • The threat of late complications. Syphilitic granulomas can appear in virtually any organ or tissue. After recovery in these places a scar is formed, which can be a certain danger. A similar scar in the wall of the aorta or the heart can cause aneurysm formation.
When a dental granuloma in the process of treatment often requires surgery. Sometimes, together with the granuloma, the top of the tooth root is removed. Then in the future, the tooth is destroyed faster and worse held in the alveoli of the gums.

In general, it can be said that the outcomes and consequences of a granuloma can be very diverse. This is influenced by the basic diagnosis, the rapid onset of proper treatment, the presence or absence of complications. In most cases, timely access to a specialist and compliance with the recommendations of a doctor allow you to avoid serious consequences in any pathology.

Is it possible to vaccinate with a granuloma?

Vaccinations are a method of specific prophylaxis of certain diseases by means of a dose load on the immune system. Once recognizing the introduced antigens, immunity will be more successful in dealing with them in the future. However, vaccination involves good health. If you vaccinate a sick child, there is a danger of some complications. First, a loaded immune system may not produce specific antibodies, and vaccination will not bring the desired effect (future protection). Secondly, antigens introduced into a weakened organism can lead to the development of the disease (or the appearance of his symptoms), from which, in fact, was vaccinated. That is why there is a fairly large number of certain contraindications to vaccination of children (temperature, cough, etc.).

A granuloma, in principle, should be regarded as a contraindication to vaccination, as it indicates the presence of health problems. The reason for its appearance is not yet known, it is better to refrain from vaccination, so as not to provoke complications.

Other diagnostic methods

In principle, for each disease that causes the appearance of granulomas, there are own analyzes and examinations. They help confirm the diagnosis, suspected by the doctor. In addition to the methods aimed at visualizing the granuloma itself, it is also important to use laboratory and microbiological methods of research. For example, a blood test and urine test can detect associated disorders and complications. Microbiological methods (serological, polymerase chain reaction, culture) are very important when it comes to the infectious process. For an adequate prescription of antibiotics you need to make an antibiotic.

There are also many specific methods that are used only in specific cases as needed. For example, when detecting granulomas of the brain or its membranes, a sample of cerebrospinal fluid should be taken. This will help to understand the nature of the disease. Laboratory and microbiological research methods do not reveal the granuloma itself, but help to understand the causes of its occurrence. This information is most important for treatment.

Annular granuloma

Annular or granular granuloma is a chronic skin disease that manifests itself as nodular round eruptions.

The pathological process is a nonspecific immune response in response to an irritant.

The disease may be asymptomatic. Most common in women and children.

Causes of disease

The etiology of the anular granuloma is unknown. The following factors are believed to lead to the development of the disease:

  • genetic predisposition (granulomatous diseases in relatives),
  • severe systemic diseases (diabetes, rheumatism, tuberculosis, sarcoidosis),
  • skin microtrauma,
  • burns
  • shingles,
  • human papillomavirus
  • violation of fat metabolism,
  • allergic mood of the body.

Annular granulomas are typical and atypical. The latter has varieties:

  • localized - represented by isolated papules,
  • disseminated - a large lesion,
  • subcutaneous - manifested in children, rash nodules located deep under the skin,
  • erythematous - with a wide crown of inflammation,
  • perforating - after healing leaves scars.

Sometimes education appears in the place of scars and tattoos.

Symptoms of anular granuloma

The pathological process begins with the appearance of single varnished, pale pink papules. Elements of the rash do not itch, do not cause pain.

After some time, the papules increase in size, forming a large round plaque. The plaque can gradually increase in size up to 5-10 cm in diameter.

Education is unevenly colored: the middle can be pale pink (normal healthy color) or bluish, and the edges - bright red. Neighboring plaques can have different stages of development. Ulceration of rash elements occurs very rarely.

The duration of the disease is from six months to 2 years.

  • the back surface of the hands, elbows, knees and feet,
  • buttocks,
  • neck,
  • shoulders and forearms
  • chest and belly
  • rarely on the face.

Disseminated granuloma develops in 15% of patients, in children such a disease is difficult to find. Round elements of a rash of pink or purple color are formed over the entire surface of the body.

Perforating the course of the disease is characteristic of young people. Localized eruptions on the fingers and hands.

Papular granulomas in the center have a small tube, through which the yellowish content flows. It dries out and forms a crust with a depression in the middle. As a result of healing, scars may remain on the eruption site.

Perforated annular granulomas are characterized by slight itching and pain at the site of injury.

Disseminated form Punching form with a crust in the center

In children, the disease occurs as benign granulomatous dermatitis. This usually occurs on the background of immunodeficiency.

More common localized granuloma - single lesion of 2-5 cm in diameter. Such eruptions are prone to peripheral growth. Relapse of the disease occurs in the same place. The epidermis is not affected.

Subcutaneous form in a child

Subcutaneous granuloma is common in preschool children.

Symptoms: deep subcutaneous nodes (from one to several pieces).

They are mobile, can be spliced ​​with a fascia or periosteum.

The formations are very similar to the manifestations of juvenile rheumatoid arthritis, but there is no connection between these diseases.

Rashes are localized, as in adults, on the dorsum of the arms and legs, sometimes the joints, the forearms, the area around the eyes and the scalp are affected.

Diagnosis of the disease

The disease has a fairly specific clinical picture, because the doctor can make a diagnosis already on the basis of the examination.

For reliability, an additional histological analysis of the biopsy from the lesion is performed. In the center is the focus of damaged collagen (protein fibers), and around - infiltration of lymphocytes. The dermis clearly shows signs of granulomatous inflammation.

Additionally, the patient needs to pass a general and biochemical blood test, an analysis for the presence of HPV in the body, blood for STIs and syphilis.

Differential diagnostics is performed with syphilis, lichen, lipoid necrobiosis, sarcoidosis, rheumatic nodules, ring-shaped erythema of Darya.

When a symptom of the disease appears, you should consult a dermatologist.

Principles of treatment of anular granuloma

Data on the effectiveness of treatment are based on the observational method. The disease is asymptomatic, because therapy is needed only to remove the cosmetic defect.

Sometimes the doctor advises expectant tactics: the lesions themselves pass within 6-18 months. It is believed that the effect of drugs comes only against the background of the spontaneous cure of the disease.

Drugs that are used in the treatment of annular granuloma:

  • hormonal drugs in the form of injections around the lesion - Kenalog 3-5 mg / cm3 in 4 injections,
  • if the rash brings pain and discomfort, topical corticosteroid ointments are used: Mometasone-Akrikhin, Elokom, Momat daily for the first 2-3 weeks, and then 1 every 2-3 days,
  • anti-inflammatory ointment containing tacrolimus blocks skin atrophy: Protopic, Tacropic. Apply 1-3 p / day for 6 weeks,
  • systemic retinoids normalize the regenerative function of the skin: Roaccutane, Aknekutan, Retasol in a dose of 0.5-1 mg / kg daily for 3-4 weeks,
  • vitamin therapy: group B, vitamin A in 5000 U, vitamin E in 400 mg every day for 2-3 months,
  • cryotherapy with liquid nitrogen in 80% of cases leads to remission. As a complication of treatment, the appearance of scars is possible,
  • UVA phototherapy allows to treat an annular granuloma with a 50% chance. The effect will require 4-5 sessions,
  • in some cases, scarification notches at the site of injury lead to recovery.

Additionally prescribed a diet with restriction of carbohydrates. Do not use flour products, sweets, pasta, fast food, etc.

It is important for the patient to know that his disease is cured by itself. Despite the unpleasant appearance of the rash, it is better to allow the granuloma to resolve naturally, because any of the above methods carries side effects.

If a person still chose therapeutic treatment, it should be under the supervision of a doctor.


Prevention of annular granuloma is the timely detection of foci of skin infection and their elimination. It is necessary to monitor the metabolic processes in the body and maintain immunity at the proper level. And also to avoid damage to the skin, hypothermia and overheating.

If you have pathological symptoms - contact your doctor.

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Does the granuloma resolve on its own?

With many pathologies, granulomas can really disappear on their own, but this does not mean that when this problem occurs, you do not need to contact a specialist. The fact is that the granulomas do not completely dissolve. They may disappear with time, but with each individual pathology, this process proceeds differently. It is possible to predict in advance whether the granuloma will resolve itself only with very few diseases.

Involution (self disappearancea) granulomas can occur as follows:

  • With an annular granuloma and a number of other skin pathologies, the granulomas can disappear themselves within a few months or years, without leaving any traces.
  • With a number of infections (syphilisa) granulomas can disappear themselves, but after that coarse scars and scars will remain.
  • With tuberculosis, granulomas can disappear themselves, if the body is fighting an infection, but it happens quite rarely.
  • Dental granulomas, as a rule, do not disappear. Only an acute inflammatory process subsides, and the symptoms disappear. The granuloma itself does not resolve and may become inflamed again in the future.
Since it is difficult to make a correct diagnosis quickly, and it is even more difficult to predict the course of the disease, it is better to consult a doctor and begin treatment. It is simply dangerous to wait until the granuloma disappears, as some infections can progress rapidly, threatening the patient’s life. Even asymptomatic granulomas can suddenly produce inflammatory complications, worsening the condition of the patient.

Antibiotics for granulomas

Antibacterial drugs are not a mandatory component of the treatment of granulomas. Their appointment may be necessary only for some patients. First of all, it depends on the disease that caused the appearance of granulomas. Most of these pathologies can be cured with antibiotic therapy for several weeks. However, if we are talking about, for example, tuberculous granulomas in the lungs, a longer course of treatment may be needed (6 - 24 months). Of course, if we are talking about infectious granulomas, then it is advisable to prescribe antibiotics only after confirmation of the diagnosis. As a rule, in this case, an antibiotic is created in the laboratory, which shows which antibiotic will be most effective in this particular case.

Another situation where it may be necessary to prescribe antibiotics is the prevention of complications. Sometimes non-infectious granulomas can become inflamed due to the ingestion of pathogenic bacteria. As a result, the patient’s condition deteriorates. If the attending physician sees the threat of such complications, he may prescribe a course of antibiotics for prophylactic purposes.

Independent use of antibacterial drugs in most cases simply will not give any effect. The patient himself cannot precisely determine why the granuloma appeared. Antibiotics taken in the wrong doses, on the contrary, can give various complications and side effects.

Ointment for granulomas

Ointments are used mainly for superficial granulomas (skin or soft tissue under the skin). Their main task is to reduce the inflammatory process and stimulate the regeneration of normal cells. With most granulomas, ointments, gels and compresses are not an effective treatment. They contribute to the relief of symptoms (itching, redness, etc.) and prevent the development of complications.

Most ointments prescribed for granulomas have the following effects:

  • Anti-inflammatory. It is necessary to reduce inflammation, swelling, pain (if they are).
  • Regenerative. The formation of granulomas causes the destruction of normal tissues. In order not to form ulcers, wounds or severe scars, prescribe ointments that promote the normal restoration of the skin (epithelialization).
  • Antibacterial. A large number of conditionally pathogenic microorganisms inhabit the skin. If swallowed, they can cause additional inflammation, pus formation and other complications. Antibiotic ointments prevent the proliferation of such bacteria in the granuloma area.
  • Antiallergic. Antiallergic ointments also help reduce inflammation, relieve itching and redness.
It must be borne in mind that in some types of granulomas many of the above drugs are not needed, and some are even contraindicated. Therefore, when the appearance of granulomas on the skin is better to contact a dermatologist, who will tell you the most effective means for each case.

Laser treatment of granulomas

Currently, laser surgery is actively developing. Laser radiation makes it possible to precisely destroy certain formations without damaging the surrounding tissues. This treatment option can be used for some types of granulomas. First of all, we are talking about superficial vascular granulomas, which are often a purely cosmetic defect. It is convenient to remove them with a laser, since at the same time the tissues “dry out” and there is no bleeding, which often complicates the removal by a conservative method.

Also, there are currently options for the removal of granulomas of the tooth with a laser. This requires special expensive equipment, so the prices for such an operation are much higher.

In the case when it comes to bulk formations (more than 1.5 - 2 cm in diameter) or the formation of pus, it is preferable to be a simple surgical intervention without the use of a laser.

Cauterization of granuloma

Technique cauterization of granulomas is no longer used in medicine. In the case of granulomas, this is, firstly, ineffective, since cauterization does not eliminate the cause of its formation. Secondly, it simply hurts, and after the procedure, massive scars remain. Now a similar technique is sometimes used in surgery to stop bleeding. An electrical discharge heats the scalpel, which simultaneously removes tissue and burns the cut point.

Currently, cauterization is often understood not as a surgical intervention, but as a drug treatment option. High temperature during classical cautery causes instantaneous “drying” of the tissue, blood coagulation and destruction of microbes. As a result, a reliable scar is formed. With a granuloma, such a rough approach is not always necessary. The place where the granuloma is removed is often burned to speed healing. However, for this purpose, concentrated solutions are used. They chemically cause the same effect as a hot metal, but without severe pain and coarse scars.

How long does the surgery to remove a granuloma last?

As mentioned above, not all granulomas need to be removed. With many diseases, they can disappear on their own or remain in the tissues for a long time, without representing a serious threat to life and health. If the granuloma must be removed, the operation time depends on its location, the presence of complications and the general condition of the patient. Patients in serious condition are dangerous to operate, and they require a longer preoperative preparation.

The main factor affecting the time of the operation is the localization of the granuloma. For example, the removal of a dental granuloma can last only 30 - 40 minutes (with anesthesia), and maybe a few hours (including complications, tooth extraction and prosthetics as necessary). Some skin granulomas are removed by laser surgery in a matter of minutes. If we are talking about the removal of the granuloma of the liver or brain, then a team of surgeons, full-fledged anesthesia and long hours of hard work during the operation itself are required. In each case, the approximate time of the operation can be obtained from the attending physician (usually at the surgeon if it is about removal).

Does the scar remain after the removal of the granuloma?

The scars after surgery are a consequence of the growth of connective tissue fibers. In this way, the body restores its integrity and returns strength to damaged tissues. Therefore, a scar, more or less noticeable, will remain after any significant surgery. Since when a relatively large granuloma is removed, it is about removing a certain amount of tissue, the scar will remain. However, the extent to which it will be noticeable depends largely on the technique of the operation.

After removal of the granulomas on the skin with a laser, the scar may not remain, but sometimes depigmented remains (bright) or pigmented (dark) speck. Surgical removal usually leaves a scar or scar, but if the tissue was neatly sewn with an intradermal suture, then the trace is almost imperceptible (narrow strip about 1 mm thick).

Should be considered in certain infections (for example syphilis) tissues are damaged during the formation of granulomas. Then the scar will remain and can be very noticeable. However, in such cases, there is usually no question of surgical removal of the granulomas.

Can the granuloma be treated with folk remedies?

Since granulomas can have different localization, nature and structure, there is no universal remedy for their treatment either among popular recipes or among pharmacological preparations. Some types of granulomas can be treated with folk remedies, but in most cases their effectiveness will be very limited. Most often, traditional medicine is used to relieve some of the symptoms in dermatology, dentistry and in general with the superficial location of defects. If we are talking about granulomas in the bones or internal organs, the effect of alternative medicine will be minimal.

With a granuloma of the tooth with severe symptoms (pain, inflammation, infection) you can use the following folk remedies:

  • Infusion of propolis. 30 g of propolis insist in a full glass of vodka for a week. After that, when pain occurs (including on the background of granulomas) you can moisten a cotton wool in the infusion and attach it to the base of the patient's tooth or to the gum in the corresponding granuloma area.
  • Garlic infusion.Garlic also insist on vodka, pre-cut it into small pieces. The standard proportion is 1 to 5 (100 grams of garlic for 0.5 liters of vodka). Infusion should last at least 10 days with daily shaking or stirring the contents. After that, the resulting infusion slightly rinse the mouth in the region of the diseased tooth. People who do not drink or children can dilute the infusion with boiled water in a ratio of 1 to 1.
  • Onion juice. Freshly squeezed onion juice can also be used with intense and prolonged toothache. To do this, it moistened cotton wool or rolled gauze and put it on the cheek to ease the pain.
  • Potato juice. When inflammation of the tooth granuloma, pus leakage, or pain, you can drink the juice from raw potatoes, rinsing the aching tooth along the way. However, this tool is not very useful for tooth enamel and with regular use can cause tooth decay. After rinsing with juice, it is recommended to thoroughly rinse your mouth again with warm boiled water.
There are other folk remedies to alleviate the symptoms of dental granulomas. However, in general, for the full treatment of the disease, they are not suitable, as the granuloma itself does not resolve from their use. They are sometimes useful as a temporary remedy before consulting a specialist and removing the problem.

There are also quite a few folk remedies for the treatment of tuberculous granulomas and tuberculosis in general. It should be noted that in this case the effectiveness of traditional medicine is also very limited. The fact is that they do not destroy the pathogen, but reduce inflammation, strengthen the immune system and slow down the development of infection. Their use will be useful only in combination with the necessary anti-TB drugs.

When detecting a tuberculous granuloma, the following folk remedies can help:

  • Garlic. Garlic has a strong antimicrobial effect. Regular consumption can slow down the development of tubercle bacilli.
  • Milk with additives. Patients with tuberculosis can not starve, as this greatly weakens the immune system and leads to the progression of the disease. To maintain the body, it is recommended to drink milk with honey and diluted animal fats in small quantities.
  • Infusion of aloe. Infusion is made from young leaves of aloe. They are cut into small pieces and squeezed juice. 200 g of honey and 300 g of dessert wine are added to 100 ml of juice. Infusion lasts at least 3 days in the refrigerator.
  • Motherwort decoction. Motherwort leaves are washed, dried and brewed as tea. It is advisable to fill it with boiling water and cook for another 5 to 10 minutes.
In general, there are quite a few different folk recipes that are recommended for use with various granulomas. However, the effectiveness of these funds in most cases is limited. Before using them it is recommended to consult with your doctor. Often, experts can, among other things, advise good preparations based on medicinal plants.

Price treatment of granulomas

Prices for treatment of granulomas can vary within very wide limits. It depends, of course, on the disease that caused the appearance of this education, and on the clinic to which the patient is referring.In most cases, treatment will be relatively inexpensive. More money will be required for a full diagnosis.

In general, prices for the treatment of various granulomas are as follows:

  • Dental granulomas in most state dental clinics are treated either with health insurance or for a moderate fee (up to 5 - 10 thousand rubles). However, deep-seated formations require a more serious approach. Operations in maxillofacial surgery for apical granulomas and granulomas of the jaw are much more expensive.
  • Infectious granulomas are treated with a course of antibiotics, which are not so expensive. The treatment of advanced tuberculosis requires a lot of money, since in this case the drugs are quite expensive, and the whole course of treatment can last 1 - 2 years. However, there are many government programs and international funds to combat the disease, which provide free treatment or material assistance.
  • Treatment of granulomas in autoimmune diseases can cost significantly more, as it requires active drug treatment with expensive drugs. As a rule, the course of treatment in these cases lasts a long time (months sometimes years).
  • Surgical removal of granulomas (if necessary) can do very expensive. It depends, first of all, on the location of the formations.

Wegener's granulomatosis in children - symptoms and treatment

Severe progressive disease, based on necrotizing granulomatous vasculitis of the upper or lower respiratory tract and systemic vasculitis of the small arteries and veins in combination with glomerulonephritis - is Wegener's granulomatosis (granulematosis wegener's). In this article, you will learn how to treat granulomatosis in a child, as well as the main symptoms of granulomatosis in children and how to diagnose it.

Granulomatous disease is a malignant disease, which is based on a vascular lesion of the type of systemic productive necrotic vasculitis. The necrotic granulomatosis with selective lesion of the upper respiratory tract and the subsequent involvement of the oral mucosa, the respiratory tract, and then the internal organs, comes to the fore.

The etiology is unknown. Among the possible causes of pulmonary granulomatosis in a child, a microbial or viral factor is more likely. Symptoms of Wegener's granulomatosis often occur after acute respiratory viral infections, hypothermia or insolation, vaccinations, antibiotic therapy, but can also develop among full health.

Violations of humoral and cellular immunity, the formation and fixation of immune complexes in the affected organs, and the activation of the blood coagulation system are of great importance in the pathogenesis.

The cause of granulomatosis in a child: pathological anatomy

The main pathological processes in Wegener's granulomatosis occur in the arteries of small and medium caliber, microvasculature vessels and veins, where there is a picture of destructive-productive and productive panarteritis, arterioliths, capillaries and venulitis.

Characterized by granulomas, located initially in the field of necrotizing lesions of the respiratory tract, and after generalization of the process - in other organs.

Granulomas consist of lymphocytes, histiocytes, polymorphonuclear leukocytes, plasma cells and often undergo necrotization.

As a result, autopsies reveal:

  • necrosis, ulcers of the nasal mucosa, oral cavity, pharynx, esophagus, trachea, often with a concomitant purulent process and destruction of surrounding tissues (including bone),
  • heart attacks, pneumonia, cavities of disintegration in the lungs with frequent abscesses and chronic deforming bronchitis,
  • hemorrhages, heart attacks and foci of kidney atrophy,
  • hemorrhage, myocardial necrosis, cardiosclerosis,
  • hemorrhages, necrosis of the mucous membrane of the gastrointestinal tract, pancreas, brain.

These changes can be bright and mild and manifest only in the upper or lower parts of the respiratory tract or in many internal organs. However, microscopic examination usually reveals systemic panvasculitis, combined with necrotizing polymorphic cell granulomas. When diagnosing, treatment should be started promptly.

Symptoms of granulomatosis

Clinically, this disease is characterized by the following symptoms: prolonged fever, necrotic changes in the upper respiratory tract or lungs, followed by generalization of the process and the addition of glomerulonephritis. Further possible clinical remission or death.

Symptoms of pulmonary granulomatosis in localized form

In the localized form, granulomatous growths on the mucous membrane of the oral cavity, in the area of ​​the sky, the arches, the tonsils appear soon after the onset of the disease, usually against the background of increased body temperature, malaise.

They have a bumpy surface, a stagnant color, a dense texture and quickly disintegrate with the formation of ulcers of different depths that do not tend to heal. Often there is a perforation of the hard palate. The resulting ulcerative process, spreading over the area and in depth, can destroy the soft tissues of the face and reach the bones of the middle third of the face, the orbits.

The addition of a secondary infection causes a fetid odor. Generalization of the disease is manifested by non-specific symptoms: high fever, chills, severe weakness, loss of body weight.

Symptoms of pulmonary granulomatosis with a generalized form

In generalized form, along with airway or eye granulomatosis, pulmonary, cardiac and skin syndromes, glomerulonephritis, myocarditis, joint damage are observed. A symptom such as damage to the eyes in granulomatosis initially manifests as “red eyes,” then the uveal tract, the lacrimal sac, is affected.

Ophthalmobiopsy is necessary, as an increase in the size of the eyeball, ptosis, impaired mobility of the eyeball can also be observed in sarcoidosis, tumors, lymphomas. The lesion of the organ of hearing occurs in combination with rhinitis, sinusitis in the form of ulcerative-necrotic changes in the nasal mucosa, oral cavity, pharynx.

Symptoms such as lesions of the trachea and bronchi, are manifested by the development of bronchial obstruction, can mimic tumors, lymphomas, patients may develop pharyngeal stenosis of the larynx, due to the occurrence of granulomas in the subpharyngeal region.

In the lungs, multiple infiltrates with signs of disintegration are detected. The pulmonary interstitium is also affected in the form of hemorrhagic alveolitis, manifested by hemoptysis.

Pulmonary hemorrhages in Wegener's granulomatosis appear in the advanced stage of the disease and in some patients cause an increasing respiratory failure.

Other manifestations are pleural reactions and lymphadenopathy.

The skin lesion is manifested by purpura, subcutaneous nodules, papules, vesicles, extensive ulcerative-necrotic lesions, which indicates generalization of vasculitis. In some patients, skin manifestations are accompanied by Raynaud's symptom.

Stages of Wegener's granulomatosis

In the development of granulomatosis in a child, there are two stages: localized (initial) and the stage of generalization.

Symptoms of granulomatosis at the stage of generalization

In a child, the disease granulomatosis begins gradually:

  • Subfebrile temperature appears, appetite worsens,
  • After a few days or weeks, the body temperature reaches 38 - 39 ° C and becomes hectic, often the child complains of pain in the joints, muscles,
  • The characteristic inflammatory and ulcerative-necrotic changes in the airways join.

What are the symptoms of granulomatosis in a child in the localized stage?

The localized stage is manifested in two ways:

  1. In the first variant, the upper respiratory tract is primarily affected: the nasal cavity, the paranasal sinuses, the oral cavity, the larynx. Such patients have the following symptoms: persistent runny nose with bloody-purulent discharge, pain in the paranasal sinuses, sore throat, difficulty in swallowing, tonsillitis. In the future, local inflammatory changes are progressing. The mucous membrane of the nasal passages, tonsils, back wall of the pharynx is necrotized, and then destruction of the nasal septum and shells occurs.
  2. In the second variant, the tracheobronchial tree and lungs are primarily affected. Patients have such symptoms of Wegener's granulomatosis as chest pain, persistent cough, and often hemoptysis. Radiographically, in the lungs, an enhanced vascular pattern is determined and infiltration of various sizes with fuzzy contours that can undergo disintegration with the formation of cavities. Less common are small focal dissemination against the background of interstitial lung changes or infiltrative darkening of the lobes.

The primary lesion of various parts of the respiratory tract is a classic symptom of Wegener's granulomatosis. But sometimes at the beginning of the disease the pathological process can be localized in the region of the orbits, skin, kidneys, and the typical picture of the disease develops later.

After a few weeks or months (sometimes years) against the background of a progressive necrotic process, the stage of generalization begins in the primary focus.

Hemorrhagic and necrotic lesions of the skin appear, and often eye changes in the form of corneoscleral ulcers, necrotic keratitis, granulomatous scleroweveitis. A number of patients with granulomatosis have symptoms of myocarditis, meningeal syndrome, exophthalmos are possible.

However, the most formidable prognostic is glomerulonephritis that joins at this stage. It occurs without arterial hypertension and is characterized by the rapid development of renal failure.

Diagnosis of granulomatosis

Before starting treatment, laboratory tests are carried out, which result in anemia, moderate leukocytosis or leukopenia, increased ESR, hypergamma-globulinemia, increased immunoglobulin M, G, E. Nephrotic syndrome is rare. With the development of renal failure appear azotemia, hyperkalemia.

Wegener's granulomatosis is acute or nodostrym.

In the acute course, the clinical picture is pronounced, generalization occurs after a few weeks or months, and kidney failure develops rapidly.

The subacute course is characterized by the slow development of clinical symptoms, the gradual occurrence of ulcerative-necrotic changes, the generalization of the pathological process is noted no earlier than one year later.

How is Wegener's granulomatosis diagnosed?

Granulomatosis is established on the basis of a comparison of the clinical picture and biopsy data of the nasal mucosa, pharynx, lung, kidney.

Diagnostic criteria are a progressive necrotic-destructive process in the nasopharynx or lungs in combination with glomerulonephritis, developing at different periods, pan-vasculitis and polymorphic-cell granulomas in the biopsies of the affected organs.

Differential diagnosis of Wegener's granulomatosis

In the localized stage, before treatment begins, a differential diagnosis has to be carried out with many diseases: tonsillitis, gangrenous granuloma, sarcoidosis, tuberculosis, Leffler syndrome, bacterial destructive pneumonia, systemic mycoses.

Dynamic observation, laboratory and instrumental methods of investigation, the results of bacterioscopic and bacteriological studies of smears from the nasopharynx or bronchial contents, the lack of effect of antibacterial therapy help to establish the correct diagnosis.

The most difficult is the differential diagnosis of granulomatosis and gangrenous granuloma, in which ulcerative-necrotic lesion of the paranasal sinuses, the mouth, and less often the ears is formed.

Diagnosis of Wegener's granulomatosis from granuloma

Gangrenous granuloma develops more gradually, sometimes over many years. The patient has chronic rhinitis, sinusitis, pharyngitis, the temperature during this period is normal or subfebrile.

Then the temperature rises to high, there is a dense swelling of the middle part of the face and a common necrotic process in the nasopharynx with perforation of the nasal septum, destruction of the bones of the upper and sometimes the lower jaw.

In the terminal phase, extensive defects of the nasopharynx are formed, sometimes extending to the entire middle part of the face, throat, larynx.

When gangrenestia granuloma does not occur visceral vascular lesions. Great help in the differential diagnosis provides biopsy.

Diagnosis of Wegener's granulomatosis from Goodpasture syndrome

With the initial localization of the process in the lungs or kidneys, it is necessary to differentiate Wegener's granulomatosis from Goodpasture’s syndrome. Goodpasture syndrome is a rare disease characterized by a combination of recurrent hemorrhagic pneumonia with progressive glomerulonephritis with outcome in renal failure.

Often, the final diagnosis is possible only after histological examination of biopsy specimens of the mucous membrane of the nasopharynx, lung or kidney.

In Goodpascher's syndrome, there are no necrotizing granulomas, diffuse extracapillary glomerulonephritis is revealed in kidney biopsy specimens with the formation of “half moon”, as well as linear deposits consisting of immunoglobulin G and Сз-component of complement.

Treatment of granulomatosis

For the period of high fever and intoxication prescribed for the treatment of bed rest, with the improvement of the patient's condition is transferred to the general mode. In case of severe necrotic lesions of the mouth, pharynx or esophagus, the child should receive mechanically and thermally sparing food. Patients with glomerulonephritis are prescribed a renal table.

Preparations for the treatment of Wegener's granulomatosis

For treatment use cyclophosphamide or a combination of it with azathioprine in a daily dose of 1-3 mg / kg. Cytostatics are usually combined with prednisone (1 mg / kg). After healing of foci of necrosis, normalization of temperature and laboratory parameters, the daily dose of cytotoxic drugs and corticosteroids is reduced to maintenance, the patient is discharged from the hospital. Maintenance treatment continues for years.

Treatment prognosis. Until recently, the prognosis of the disease was hopeless, the average life expectancy was 6 - 12 months. The prognosis improved with the use of cytostatics in the treatment of Wegener granulomatosis.

With early diagnosis and timely treatment started (in the localized phase), most patients recover.

The prognosis after treatment remains unfavorable, if anti-inflammatory and immunosuppressive therapy is prescribed only in the phase of generalization in the presence of glomerulonephritis.

In this case, relative remission may occur, but death is still not uncommon in the future, due to renal failure or arrosive bleeding.

In this article, we listed all the symptoms and methods of treating Wegener's granulomatosis in a child. Health to your children!

Causes and classification

This skin disease is called dermatosis, the causes of which can be very many.Chronic bacterial infections, endocrine disorders, hypovitaminosis, viruses and allergic diseases are factors that trigger the onset of the disease.

Depending on the prevalence and extent of skin lesions, the following types of diseases are distinguished:

  1. Localized - the most common form of the disease.
  2. Papular - small papules are formed.
  3. Deep subcutaneous process.
  4. Disseminated - when there are common lesions in the body.
  5. Punching.

Disease peculiarity

The localized form is manifested by granulomas located on the skin in the form of rings, half rings on the hands, feet, legs and forearms.

Occasionally there is a lesion of the scalp, the area around the eyes. Small foci have a tendency to merge, and large foci can reach 5–7 cm in size. In the center of ring-shaped granulomas there is a bluish or purple skin. Pain, itching and other discomfort usually not.

The papular form of the annular granuloma is distinguished by the appearance of nodules isolated from each other. These formations do not merge with each other, they are always clearly delimited from each other.

With a deep ring-shaped granulome, the nodules are located under the skin, while the epidermis is not affected. Occurs more often in a child under 6 years of age and is located under the skin of the legs, forearms, elbows, dorsum of the hands and sometimes the scalp. The hypoderm may suffer near the eyes, the upper eyelid also suffers from time to time.

The lesion located subcutaneously, as a rule, is easily displaced. Only on the scalp are the nodules immobile. Surgical treatment of this pathology is not effective, because the process soon recurs, i.e. nodules under the skin are formed again.

In children, in more than 90% of cases, disease is a localized form.

In the disseminated process, the lesions of the rash are located on the skin of the whole organism. Adults are more often affected, it is extremely rare in children.

Perforation annular granuloma is located on the back of the hands and fingers. More often the disease affects children. The ring-shaped hearth has a crust or cork in the center, after removal of which a jelly-like yellowish content is released. It has a tendency to merge. After resorption of these formations on the skin remain thinned pale areas, which means the destruction of collagen.

Differential diagnostics

Ring-shaped granuloma, must be differentiated with the following conditions:

  1. Necrobiotic foci. The formation of nodules on the skin, with disorders of carbohydrate metabolism, which, when merged, form plaques, mainly on the legs, with a shiny surface.
  2. Brown and blue knots. More common on the face in adults with sarcoidosis.
  3. Red lichen planus. May be accompanied by itching. The skin elements have not a ring-shaped, but a polygonal shape and a brighter pink-purple color.
  4. Rising erythema. Located mainly around the joints, have distinct signs of inflammation. The rash is usually more numerous than with ring-shaped granulomas.
  5. Rheumatoid nodules. Often painful when probing, and more deeply located, accompanied by the appearance in the analysis of acute phase indicators of inflammation, joint damage, weakness and fever.
  6. Pyogenic granuloma. Benign vascular tumor, or lobular hemangioma. Most often pyogenic granuloma occurs in children and adolescents. It affects not only the skin of the scalp and upper extremities. Pyogenic granuloma (botriomikoma) likes to be located on the mucous membrane of the esophagus, gums, lips, larynx, nose, conjunctiva, cornea. A provoking factor may be trauma, burns, infections and skin diseases. Pyogenic granuloma is characterized by excessive growth of capillaries.

The treatment has the following tasks:

  1. To cause a decrease in rash.
  2. Prevent recurrence of the disease.

It must be remembered that the annular granuloma can disappear on its own.
It is necessary to pay attention to:

  1. The treatment of chronic foci of infection
  2. Correction of carbohydrate metabolism.

For the purpose of local treatment applied cream and ointment with glucocorticoids, nonsteroidal anti-inflammatory drugs.
Glucocorticoid local remedies:

  • hydrocortisone,
  • Alclomethasone dipropionate,
  • betamethasone dipropionate,
  • betamethasone valerate,
  • methylprednisolone aceponate,
  • mometasone furoate,
  • clobetasol propionate.

Non-steroidal local agents:

Systemic therapy with vitamins:

  • laser therapy
  • irrigation with chloroethyl to obtain persistent “frost”,
  • liquid nitrogen quenching.

Before performing physiotherapeutic treatment, consultation with a phthisiatrist, ENT doctor, endocrinologist, infectious disease specialist, or pediatrician is necessary.

The disease is treated on an outpatient basis. As a rule, indications for hospitalization are absent. There are no specific methods of prophylaxis for the disease. As the ring-shaped granuloma looks like, it can be seen in the photo.


When treating any form of ring-shaped erythema, it is imperative to remember that one of the trigger mechanisms of the disease is an allergic component. The following medicinal plants give a good effect: celandine, lemon balm, yarrow, St. John's wort, lingonberry, rosehip, mountain ash, mistletoe, nettle and elderberry.

But, they can also cause the strongest allergic reaction. Therefore, it is necessary to coordinate your desire to be treated with folk remedies, with your doctor.

Etiology of the annular granuloma in children on the skin

In a broad sense, the annular granuloma in children is a type of chronic dermatosis unknown etiology. The disease develops gradually and is prone to relapses.

In medical practice, there are cases of self-disappearance of pathology without the use of special measures of therapy.

Such examples are rare and directly related to the individual characteristics of the child's body. If symptoms of granuloma occur It is necessary to consult a specialist as soon as possible..

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The concept and characteristics

Ring-shaped granuloma in children - photo:

Annular granuloma is a rare skin disease. Pathology distinguished by a benign course. Dense nodules on the skin form a characteristic ring.

Such formations can be localized on any part of the child’s body, but most often symptoms manifest themselves on the scalp, feet, chest area or back.

Children with a tendency to dermatitis and low immunity are at risk of the disease.

Features diseases:

  • the symptoms of annular granuloma can arise and disappear on their own,
  • in most cases, the symptoms of the disease are not accompanied by pain, itching or burning of the skin.

Causes and factors of development

Annular granuloma refers to the number of diseases idiopathic type.

The causes of the development of pathology remain poorly understood.

Based on the research, a list of factors that can trigger such a skin lesion has been compiled. According to most experts, the main cause of annular granuloma is impaired cellular immunity.

The following can provoke the development of pathology factors:

  • the consequences of a long stay of the child in the sun (sunburn),
  • the body’s specific reaction to manta or other vaccinations,
  • the negative effects of insect bites,
  • the formation of warts on the skin,
  • effects of skin diseases
  • tuberculosis,
  • diabetes,
  • endocrine diseases
  • violation of metabolic processes in the body,
  • genetic predisposition
  • consequences of skin injuries,
  • autoimmune processes in the body.

Pediatricians' recommendations for treating vitiligo in children can be found on our website.

Symptoms and signs

In some cases, the annular granuloma may develop asymptomatic.

The process of disease progression in this form lasts for years. Visually, the ring-shaped granuloma resembles a chain of plaques or papules.

The color of the formations may not differ from the skin or acquire reddish purple white and other shades.

The size of the formed ring can reach several centimeters in radius. By signs Diseases are the following factors:

  • formations may resemble pigment spots, but differ from them in structure and color,
  • nodules are formed on the skin, connecting in a ring,
  • nodules have a yellowish tint,
  • rings can overlap each other,
  • in children, the disease is most often localized in the region of the legs, flexion of the limbs or hands,
  • the surface of the nodules is always smooth and shiny,
  • ring-shaped granuloma does not cause pain to the child.

Diagnostic methods

In most cases, the diagnosis of annular granuloma in children is limited visual inspection. If there are suspicions of concomitant diseases, doctors prescribe additional types of examination.

In some cases it is necessary differential diagnosis from lichen planus, pyogenic granuloma and rheumatoid nodules.

Methods for diagnosing annular granuloma:

  • skin sample from the affected area,
  • urine and blood count
  • histological examination
  • biochemical analysis of blood and urine.

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Treatment methods

The course of treatment of ring-shaped granulomas in children depends on the individual characteristics of the child’s body and the presence of concomitant diseases. In most cases, experts use waiting tactics.

Drug therapy is prescribed if there is no tendency to self-cure from the disease.

In addition to drugs, special procedures can be used. These include liquid nitrogen, carbonic snow, or irrigation of the site of Chlorethyl damage.

In the treatment of annular granulomas in children The following types of drugs are used:

  • means of improving blood microcirculation (Tocopherol, B vitamins, Retinol, iron preparations, Ascorbic acid),
  • nonsteroidal local remedies (phenylbutazone, indomethacin),
  • corticosteroid ointment (psoriderm),
  • hormonal ointments (Triderm, Dermoveit),
  • topical glucocorticoid drugs (Hydrocortisone, Betamethasone valerate),
  • preparations for injecting foci of the disease (Acetonide, Diapson).

Folk remedies

When using traditional medicine for the treatment of ring-shaped granulomas in children, it is important to consider that the disease can have allergic nature.

Selection of recipes for alternative medicine is carried out with the exception of ingredients that can aggravate the body's response to certain stimuli.

It is impossible, for example, to use products based on honey, berries that can cause allergies, as well as other components with similar properties.

Examples folk remediesused in the treatment of annular granuloma in children:

  1. Celandine and glycerin. Mix pharmacy glycerin and 30% celandine tincture in equal amounts, from the obtained product to do compresses on the skin lesions, the procedure should be carried out once, preferably at bedtime.
  2. Herbal tea. Five tablespoons of rosehip leaves mixed with one tablespoon of crushed roots of elecampane, pour boiling water over the billet and boil for fifteen minutes, use the resulting product as a tea once a day.
  3. Radish, carrots and lemon juice.

Mix 200 ml of radish and carrot juice, add one tablespoon of lemon juice.

A means to take three times a day for a tablespoon.

Recommendations of Dr. Komarovsky

Dr. Komarovsky recommends that, in addition to the basic measures for the treatment of ring-shaped granulomas in children protective measures for the affected skin.

Nodes should not be subject to friction of clothing, be injured or be exposed to other mechanical effects. Such factors can aggravate the situation and cause negative consequences.

Doctor advises:

  • observe the rules of personal hygiene and prevent contamination of the affected skin,
  • treat lesion sites with prescribed ointments,
  • if the disease does not go away for a long time or is prone to frequent relapses, then radical measures should be taken (rounding, treatment with liquid nitrogen, etc.),
  • when treating a disease, it is necessary to use the tactics of waiting for his self-healing.

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