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Granulomas in dentistry

Granulomas teeth and gums are, along with caries, one of the most common problems in dentistry. Their prevalence is quite difficult to estimate, but a significant part of the population at least once encounters a similar problem during their lives. In principle, granulomas of the teeth, gums and jaw usually do not pose a serious danger. These are localized formations that pose a certain threat only when infected and inflamed. This thunderstorm is associated with various complications.

Tooth granuloma

A dental granuloma is a dense nodular formation, which in most cases is located near the root apex. The main reason for the formation of such granulomas is considered to be the spread of infection or inflammation in certain dental diseases. As a result of infection, a small compaction forms, from which a granuloma gradually forms. The vast majority of dental granulomas are asymptomatic until reinfection occurs. Then the inflammatory process manifests itself more strongly, since there is a deep focus.

The following diseases are considered the main causes of dental granulomas:

caries, during the development of which infection through the canal can reach the root;
periodontitis ( inflammation of the tissues that are located in the dental socket of the jaw);
gum injuries;
infection during tooth filling ( if the clinic doesn’t sterilize instruments well);
poor oral hygiene;
congenital anomalies of dental development.

Symptoms of granuloma appear quite quickly. Usually their appearance is facilitated by stress, hypothermia, colds or other external factors that can weaken the immune system. As a result, a purulent focus often forms at the site of the granuloma.

An exacerbation of dental granuloma is usually accompanied by the following symptoms:

pain in the tooth and gum;
leakage of pus at the base of the tooth;
swelling of the gums;
temperature increase ( sometimes strong during purulent process).

Some dental granulomas tend to grow gradually. Then the symptoms of the disease will appear gradually as the surrounding tissues are compressed.

Granuloma of the root apex ( apical granuloma)

Apical granuloma is the most common type of dental granuloma. It is located at the very top of the root and thus lies quite deep in the gum. Over time, apical granulomas can transform into a jaw cyst. Then a pathological cavity is formed in the thickness of the jaw, which is fenced off by dense connective tissue and contains dead tissue and bacteria. In severe cases, the disease can develop into an abscess, in which purulent damage to the surrounding tissue occurs, or into osteomyelitis of the jaw, when bone tissue undergoes purulent melting.

Interradicular granuloma

Interradicular granuloma is a variant of dental granuloma, in which the inflammatory focus is not located at the very apex of the root, but a little closer to the surface, under the main mass of the tooth. Such granulomas form slowly. The inflammatory process is prolonged and can produce severe symptoms for a long time. In most cases, it does not spread to the surrounding soft tissue or adjacent teeth. The interradicular location of the granuloma can be confirmed using an x-ray. In most cases, it is not possible to save a tooth with intense inflammation. It is recommended to remove it followed by treatment of the inflammatory focus.

Granuloma on the gum

Granulomas on the gums are not always a consequence of dental granuloma. Sometimes infectious processes affect the gums only superficially, being localized, in fact, on the mucous membrane. In these cases, the tooth may be completely healthy, and its removal during treatment is not always necessary. When a granuloma is located on the gum, the doctor must take into account the possibility of diseases not directly related to the teeth and devote enough time to diagnosis.

Odontogenic granuloma

The term "odontogenic" in medicine means "derived from the tooth." Odontogenic granuloma is commonly referred to as a migratory subcutaneous granuloma in which the initial site of infection is located near the root of the tooth. The disease is a sluggish inflammatory process in the subcutaneous tissue, which may not produce pronounced symptoms. The recommended treatment is identification and removal of the original lesion.

Granuloma with pulpitis and periodontitis

Pulpitis is an inflammation of the pulp, the soft tissue inside the tooth that contains nerves and blood vessels. Periodontitis is an inflammation of the dental bed, consisting of several membranes that line the alveoli ( hole) jaws. Both of these diseases can cause granuloma formation. Actually, granuloma will be the result of the body’s fight against the infectious process. The symptoms of pulpitis and periodontitis are not very different from the symptoms of granuloma itself ( during exacerbation).

Flux for granuloma

Flux is a purulent inflammation, the focus of which is located under the periosteum of the jaw. Currently, a more precise term is often used in medicine – odontogenic periostitis. This pathology may well be a complication of dental granuloma, which was not cured in time. Flux is a much more serious and dangerous disease than just an inflamed cyst or granuloma. This is explained by the deep location of the lesion and the high risk of spread of the purulent process.

The main signs and symptoms of flux are:

constant pain;
pronounced swelling of the gums ( usually under several teeth);
bursting of pus into the oral cavity;
swelling of the cheek;
enlargement of lymph nodes located near the lesion;
temperature increase;

Treatment of flux for granuloma is only surgical. The doctor makes an incision and empties the cavity of pus. After this, a course of antibiotics is necessary to prevent the pus from accumulating again.

Complications of granuloma

Many granulomas themselves do not pose a serious threat to the life and health of patients. However, it should be remembered that any granuloma is a pathological formation and a deviation from the norm. Ignoring the problem can lead to quite serious complications over time. Even if the formation does not manifest itself in any way, this does not mean that it will go away on its own or will not give symptoms in the future. The condition of the body is constantly changing, and some external and internal factors can cause an exacerbation of the disease.

Is granuloma a dangerous disease?

Granuloma itself is not a separate disease, so it poses an immediate danger. However, the diseases that cause granulomas can be quite serious. Therefore, if a granuloma is detected, all patients are advised to consult a specialist for a full diagnosis.

Most superficial granulomas ( cutaneous and subcutaneous) do not pose a serious danger, but may be a significant cosmetic defect. For example, granuloma annulare often causes no symptoms and may go away on its own over time. However, granulomas on the skin can also be a manifestation of severe infectious diseases.

The most dangerous pathologies that cause the appearance of granulomas are:

tertiary syphilis;
histiocytosis;

With these diseases, granulomas can appear in various tissues and organs, seriously disrupting their functioning. Patients with sarcoidosis, for example, often develop respiratory failure over time. Listeriosis in newborns can affect a variety of organs and often leads to death.

Diseases such as dental or post-traumatic granuloma do not pose a serious threat to life provided there are no complications. Complications are most often local in nature and respond well to treatment.

Thus, the danger of a granuloma to the life and health of the patient is determined by the main diagnosis - the disease that caused the appearance of the granuloma.

Inflammation and infection ( suppurative granuloma)

Inflammation of the granuloma itself is not quite the correct formulation. The granuloma itself is the result of granulomatous inflammation, so its re-inflammation is not a completely correct definition. However, most granulomas are characterized by a slow inflammatory process and do not produce pronounced symptoms. Weakening of local protection at the site of granuloma can lead to another infection. For example, a dental granuloma itself may not cause any symptoms for a long time. The patient may not even know about it. However, when an infection enters the lesion, it usually causes an active inflammatory process and the formation of pus. As a result, the temperature rises, severe pain appears, and regional lymph nodes enlarge ( submandibular, parotid, etc.).

Thus, the immediate cause of acute sudden inflammation of the granuloma is the ingress of ordinary pyogenic microflora. Most often these are staphylococci or streptococci, which normally live on the surface of the skin or in the oral cavity.

In order to detect granuloma inflammation in time, you need to pay attention to the following signs of this complication:

redness of the lesion;
the appearance of dull pain that worsens with pressure or touch;
local temperature increase;
local swelling and increase in size of the formation;
enlargement of regional lymph nodes.

In most cases, inflammation or infection of the granuloma requires urgent medical attention, as the process can spread. Treatment may require antibiotics and sometimes surgery.

What to do if a granuloma bursts?

A granuloma, unlike a cyst, does not have an internal cavity filled with fluid. This is a knot consisting of dense tissue. As a result, the granuloma simply cannot burst. However, some types of granulomas may enlarge, become inflamed, or gradually develop into ulcers ( ulcerate). Patients then feel as if the granuloma has “burst.”

The main sign that the granuloma has “burst” is the leakage of fluid from the inflammatory focus. This is usually pus that forms due to infection of the affected area. The granuloma itself does not secrete fluid, but can be melted by the same purulent process. The most striking example is inflammation of dental granuloma. From the location of the granuloma, pus or blood gradually begins to leak, which enters the oral cavity. The patient develops an unpleasant taste in the mouth, bad breath, bleeding gums, and increased pain.

If the patient feels that the granuloma has burst, proceed as follows:

If signs of tooth granuloma suppuration appear, you need to carefully brush your teeth and rinse your mouth with boiled water and disinfectant solutions.
It is not recommended to eat spicy, salty or too hard foods, so as not to worsen the condition of the gums.
You can take painkillers or anti-inflammatory drugs.
It is necessary to contact a dentist as soon as possible. Antibiotics and more effective rinses are usually prescribed. Surgery may also be required.
Granulomas on the skin or subcutaneous tissue “burst” much less often. If the abscess at the site of the granuloma has opened, you need to carefully rinse it with warm boiled water.
Apply a dry, clean bandage to the resulting wound.
You need to contact a specialist ( surgeon or dermatologist), who will determine the nature of the lesion and prescribe the necessary treatment.

Granulomas that form in internal organs can destroy surrounding tissue, dissolve, or turn into cysts. Sometimes this is accompanied by the appearance of various symptoms and a deterioration in the patient’s condition. However, the patient himself does not notice that his granuloma has “burst.” In any case, if you suspect the development of any complications, you must notify your doctor as soon as possible.

Fistulas

A fistula is a pathological formation, an opening connecting a hollow organ or any cavity with another cavity or the environment ( external fistula). In principle, fistulas do not form with 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 may have fistulas. Thus, such a complication as a fistula often forms after the disintegration 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 leakage of pus, blood or intercellular fluid that accumulates in the cavity. Fistulas are a surgical problem. Due to the threat of secondary infection, when they appear, you must definitely consult a doctor and remove this formation surgically.

Recurrence of granuloma

Relapse is the repeated development of a disease associated with incorrect or insufficiently effective treatment. Re-infection ( for infectious diseases) is not considered a relapse. If we are talking about a granuloma, then its reappearance after removal or resorption of the defect detected for the first time can be considered a relapse.

Whether the granuloma will recur or not depends entirely on the reasons that caused the problem and on the quality of treatment. Recurrence of granuloma is, in principle, possible with many infectious or autoimmune processes. Granulomas caused by foreign bodies or trauma do not recur after the cause of their formation is eliminated.

Recurrence of granuloma is theoretically possible in the following pathologies:

Sarcoidosis. Sarcoidosis is an inflammatory process caused by autoimmune mechanisms. With intensive treatment, granulomas often disappear, but complete recovery is usually not achieved. Over time, granulomas appear again.
Tuberculosis. Tuberculous granulomas are formed due to tissue destruction ( usually in the lungs) and their isolation by special cells. The course of treatment involves long-term intensive antibiotic therapy. This is necessary, since the causative agent of tuberculosis is practically insensitive to most antibacterial drugs. After treatment, granulomas may disappear or become calcified ( be covered with a dense capsule of calcium). In both cases, doctors can talk about recovery. Unfortunately, many patients experience relapses. Tuberculosis bacteria are very common and are resistant to many anti-tuberculosis antibiotics.
Syphilis. Syphilitic gummas usually appear in the later stages of the disease and can be located in various organs and tissues. As a rule, new granulomas appear during a period of weakened immunity. Over time, most gummas heal, leaving scars and scars. However, if the causative agent of the disease is not eliminated ( through the correct course of antibiotic therapy), then granulomas will appear again. The immediate cause of their formation in syphilis is the repeated reproduction of treponemes ( pathogen) and their entry into tissues with the bloodstream.
Fungal infections. Fungal infections often cause the formation of granulomas in the lung tissue. Antifungal drugs that are used for treatment kill a significant number of fungi, so the granulomas can resolve. However, this does not always mean complete recovery. The infection itself may remain in the tissues, and within a few weeks after early interruption of treatment, granulomas may form again. This occurs especially often in individuals with severely weakened immune systems.
Histiocytosis. Histiocytosis is characterized by the appearance of numerous granulomas in various organs and tissues. This disease is difficult to treat, and the disappearance of granulomas is usually temporary.
Rheumatoid arthritis. Aschoff-Talalaev granulomas, which form with this pathology in the joint area, 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 very rarely possible to cure it completely. Most often, after some time, a re-exacerbation occurs, and granulomas appear again. True, they may appear in other places ( in the area of other joints).

What is the outcome and consequences of granuloma?

Basically, there are two different outcomes of granulomas. In the first case, they dissolve and disappear on their own, leaving no traces. This recovery option is possible for some infections and autoimmune processes. For example, granuloma annulare of the skin in the vast majority of cases goes away without a trace ( sometimes even without special treatment). With proper treatment, granulomas in sarcoidosis can shrink.

The second option is the disappearance of the granuloma with the formation of a scar or scar. Moreover, such a scar can be located both on the surface of the skin and in the thickness of tissues, and even inside organs. The mechanism of scar formation is quite simple. Some granulomas destroy normal tissue as they develop. To compensate for the defect, the body produces connective tissue fibers, which form a scar. Coarse scars that interfere with the functioning of internal organs and greatly spoil a person’s appearance are formed after the disappearance of syphilitic granulomas. There is also a third option, which is quite rare. This is granuloma calcification. Tissues accumulate large amounts of calcium and become calcified ( like a shell or pebble). Such lesions remain with patients until the end of life ( unless they are removed surgically). A similar mechanism sometimes occurs in patients with pulmonary tuberculosis. The infection is defeated, but a Gon lesion remains in the lungs ( calcification), which will be visible on x-rays for the rest of your life.

In general, after recovery, patients with granulomas may have the following consequences:

Cosmetic defects. May appear if the patient had superficial granulomas due to syphilis, chlamydial infection ( inguinal granuloma), after injuries.
Failure of organs. Granulomas in the lungs, for example, can cause widespread and irreversible tissue damage. Then the patient will suffer from respiratory failure for the rest of his life. Liver failure or kidney failure are also possible ( depending on the location of the granulomas).
Threat of late complications. Syphilitic granulomas can appear in almost any organs and tissues. After recovery, a scar forms in these places, which can pose a certain danger. Such a scar in the wall of the aorta or heart can cause the formation of an aneurysm.

Dental granuloma often requires surgery during treatment. Sometimes the tip of the tooth root is removed along with the granuloma. Then in the future the tooth is destroyed faster and stays worse in the gum alveolus.

In general, we can say that the outcomes and consequences of granuloma can be very diverse. This is influenced by the main diagnosis, the rapid initiation of proper treatment, and the presence or absence of complications. In most cases, timely contact with a specialist and compliance with the doctor’s recommendations allow you to avoid serious consequences for any pathology.

Is it possible to get vaccinated for granuloma?

Vaccinations are a method of specific prevention of certain diseases through a dosed load on the immune system. Having recognized the introduced antigens once, the immune system will be more successful in fighting them in the future. However, vaccination presupposes good health. If you vaccinate a sick child, there is a risk of some complications. Firstly, a loaded immune system may not produce specific antibodies, and the vaccination will not bring the expected effect ( future protection). Secondly, antigens introduced into a weakened body can lead to the development of the disease ( or the appearance of its symptoms), from which, in fact, the vaccine was given. That is why there are quite a large number of specific contraindications to vaccination of children ( fever, cough, etc.).

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

Diagnosis of granuloma

The detection of granuloma itself in most cases does not present any particular difficulties. Many patients, when visiting a doctor, complain about dense formations on the skin, under the skin or in soft tissues. It is somewhat more difficult to detect granulomas located deeper in the internal organs or in the thickness of soft tissue. However, in these cases instrumental studies help. Currently, there are quite a few ways to study body tissues. The most common are ultrasound, radiography, computed tomography, etc.

It is much more difficult to make a correct diagnosis. In other words, it is not difficult to confirm the presence of the granuloma itself, but it is sometimes very difficult to say why it appeared. This may take weeks and even months, collecting a large number of tests, and visiting specialists of various profiles.

It is most difficult to confirm the diagnosis for the following diseases:

listeriosis;
Wegener's granulomatosis;
granuloma annulare;
eosinophilic granuloma ( histiocytosis);
sarcoidosis

The problem is that these pathologies are very rare. Doctors, first of all, will look for the simplest and most common diseases. In addition, the small number of patients with the above diseases explains the fact that even specialists do not know much about their diagnosis and treatment.

Who diagnoses granulomas?

As noted above, granulomas can be found in almost any organ or tissue of the body. As a result, they are detected by doctors of various specialties. In most cases, this is a general practitioner or family doctor to whom patients turn for an initial examination. Often it is he who suspects the presence of granulomas and prescribes the necessary tests to confirm the diagnosis. He can also prescribe consultations with other specialized specialists.

In addition to the therapist, various types of granulomas can be detected by the following specialists:

radiologist - during preventive examination;
surgeon - during the operation;
rheumatologist – when monitoring patients with rheumatoid arthritis and other autoimmune diseases;
dermatologist - if granulomas are detected on the skin;
dentist - when granulomas are localized in the oral cavity.

In principle, the above specialists are also involved in the treatment of the corresponding localization of granuloma. If necessary, doctors from other fields of medicine can also be invited for consultation.

Ultrasonography ( Ultrasound)

Ultrasound is one of the most common diagnostic methods. Its main advantages are relatively low cost, safety for patients and quick results. The method is based on obtaining an image using sound waves that are sent into the thickness of the body tissues. Due to different tissue densities, waves are reflected differently, and with the help of special sensors, the doctor can determine the contours of organs and pathological formations.

Granulomas most often consist of denser tissue, so they can be detected using ultrasound. The disadvantage of this method is that it only reveals the presence of the formation itself, its size and location. However, the cause of the granuloma cannot be diagnosed by ultrasound. This will require other, more specific diagnostic methods.

Most often, ultrasound determines granulomas in the following organs and tissues:

spleen;
intestinal walls;
soft tissues ( fat and muscle);
enlarged lymph nodes, etc.

X-ray ( snapshot)

X-ray examination these days is a routine procedure that is often performed for preventive purposes. X-ray radiation, passing through body tissues, can detect various formations in internal organs or bones. It is impossible to make an accurate diagnosis based on an x-ray, since the internal structure of the formation is not visible.

X-ray examination for granulomas can help in the following cases:

clarification of the location of the granuloma;
detecting signs of complications;
preventive photographs after removal or disappearance of granulomas ( for the purpose of timely detection of relapse);
detection of concomitant pathologies.

It should be noted that granulomas, similar in density to the surrounding tissues, will be difficult to distinguish on an x-ray. To detect them, it is better to use other examination methods. In practice, radiography is most often used in dentistry to detect dental granulomas.

Histological examination ( biopsy)

Biopsy and subsequent histological examination is one of the most accurate diagnostic methods in the case of granulomas. The fact is that each type of granuloma has a unique structure. It is characterized by certain pathological cells that are not so difficult to detect under a microscope. The biopsy itself is a tissue sampling procedure. Sometimes a small area is cut off from the lesion, sometimes the entire removed lesion is sent for histological examination.

It is advisable to carry out a biopsy and histological examination for granulomas for the following reasons:

determining the correct diagnosis;
assessment of the stage of disease development;
exclusion of similar malignant neoplasms.

The fact is that many granulomas on the skin and in internal organs can be similar on ultrasound or x-ray to small malignant neoplasms ( cancerous tumors). It is also very difficult to distinguish them externally during surgery. Histological examination, carried out under a microscope in the laboratory, allows you to accurately determine the cellular structure of the formation. If it is discovered that the granuloma is the initial stage of cancer, then the patient is sent to an oncologist. In addition to removal of the granuloma, courses of radiation therapy or chemotherapy may be required.

It is better not to remove granulomas resulting from systemic infections, even for the purpose of histological examination, as this can lead to the spread of infection. To detect the pathogen, there are other laboratory diagnostic methods.

Other diagnostic methods

In principle, each disease that causes granulomas has its own tests and examinations. They help confirm the diagnosis suspected by the doctor. In addition to methods aimed at visualizing the granuloma itself, the use of laboratory and microbiological research methods is also important. For example, blood tests and urine tests can detect associated disorders and complications. Microbiological methods ( serological, polymerase chain reaction, culture) are very important when it comes to an infectious process. To adequately prescribe antibiotics, you need to do an antibiogram.

There are also many specific methods that are used only in specific cases when necessary. For example, if granulomas of the brain or its membranes are detected, a sample of cerebrospinal fluid must be taken. This will help 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.

Treatment of granuloma

Treatment of granulomas depends entirely on the causes that caused the disease. In general it looks like this. If the granulomas are infectious in nature, the basis of treatment will be a course of antibiotics. If we are talking about autoimmune processes, anti-inflammatory drugs are required ( often hormonal) drugs and other narrowly targeted drugs. In the case of dental granuloma, post-traumatic granulomas and other formations that are not prone to progression and are localized, surgical removal of the defect is possible. Treatment tactics in each individual case should be discussed with your doctor. It is recommended to take a responsible approach to diagnosing the underlying disease, as this determines the success of treatment.

Do granulomas need to be treated?

Granuloma itself is not a separate disease, but it should be taken very seriously. Quite often, the appearance of these formations indicates acute or chronic pathological processes in the body. The appearance of granulomas cannot be ignored, since they can be only one of the manifestations of deadly pathologies ( listeriosis, histiocytosis, tuberculosis, etc.).

Patients with granuloma are advised to immediately consult a specialist to clarify the diagnosis. In some cases, granulomas may not pose a serious threat, and then urgent treatment is not required. For example, granuloma annulare most often disappears after some time on its own, and there are no effective medications to speed up this process. At the same time, delaying treatment for neonatal granulomatosis ( listeriosis) can decide the issue of life and death not in favor of the patient.

Thus, some types of granulomas do not require immediate treatment. However, contacting a specialist to at least clarify the diagnosis is necessary in all cases.

Therapeutic ( medicinal) treatment of granuloma

Drug treatment for granuloma is always required, but it is not always sufficient for complete recovery. Its main goal is to eliminate the causes and mechanisms that led to the development of granuloma. In most cases, with conservative treatment, granulomas gradually scar or disappear without any consequences.

Does granuloma resolve on its own?

In many pathologies, granulomas can indeed disappear on their own, but this does not mean that if this problem appears, you should not contact a specialist. The fact is that granulomas do not completely resolve. They may disappear over time, but for each individual pathology this process occurs differently. It is possible to predict in advance whether a granuloma will resolve on its own only in very few diseases.

Involution ( self-disappearance) granulomas can occur as follows:

With granuloma annulare and a number of other skin pathologies, granulomas can disappear on their own within a few months or years, without leaving any traces.
For a number of infections ( syphilis) granulomas may disappear on their own, but after this, rough scars and cicatrices will remain.
With tuberculosis, granulomas can disappear on their own if the body fights the infection, but this happens quite rarely.
Dental granulomas usually do not disappear. Only the 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 quickly make a correct diagnosis, and even more difficult to predict the course of the disease, it is better to consult a doctor and begin treatment. Waiting for the granuloma to disappear on its own is simply dangerous, as some infections can progress quickly, threatening the patient’s life. Even asymptomatic granulomas can suddenly develop inflammatory complications, worsening the patient's condition.

Antibiotics for granuloma

Antibacterial drugs are not a mandatory component of the treatment of granuloma. 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 within a few weeks. However, if we are talking, for example, about 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 confirming the diagnosis. As a rule, the laboratory also compiles an antibiogram, which shows which antibiotic will be most effective in this particular case.

Another situation where antibiotics may be necessary is to prevent complications. Sometimes non-infectious granulomas can become inflamed due to the entry of pathogenic bacteria into them. As a result, the patient's condition worsens. If the attending physician sees the threat of such complications, he may prescribe a course of antibiotics for preventive purposes.

Self-administration of antibacterial drugs in most cases simply will not have any effect. The patient himself cannot determine exactly why the granuloma appeared. Antibiotics taken in the wrong doses, on the contrary, can cause various complications and side effects.

Ointments for granuloma

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. For most granulomas, ointments, gels and compresses are not an effective treatment method. They help relieve symptoms ( itching, redness, etc.) and prevent the development of complications.

Most ointments prescribed for granulomas have the following effects:

Anti-inflammatory. Necessary to reduce inflammation, swelling, pain ( if they are).
Regenerative. When granulomas form, normal tissue is destroyed. To prevent the formation of ulcers, wounds or rough scars, ointments are prescribed that promote normal restoration of the skin ( epithelialization).
Antibacterial. A large number of opportunistic microorganisms live on the skin. If they enter tissues, they can cause additional inflammation, the formation of pus and other complications. Antibiotic ointments prevent the proliferation of such bacteria in the granuloma area.
Antiallergic. Ointments with an antiallergic effect also help reduce inflammation, relieve itching and redness.

It should be borne in mind that for some types of granulomas, many of the above drugs are not needed, and some are even contraindicated. Therefore, when granulomas appear on the skin, it is better to consult a dermatologist, who will suggest the most effective remedy for each specific case.

Surgical treatment of granuloma

Not all granulomas necessarily require surgical treatment. Many formations caused by infectious or autoimmune processes are, in principle, useless to remove. Surgical treatment is preferable for a fairly small number of pathologies. Most often it is needed for dental granulomas.

Granulomas in case of systemic diseases and infections are not removed for the following reasons:

if the formations are multiple, various organs may be affected ( then it is simply impossible to remove them all);
high risk of relapse ( re-formation of granuloma);
there is a risk of spreading infection;
granulomas can be located very deep, which greatly increases the scope of the operation;
the risk of complications when removing a granuloma is often higher than from the disease itself;
many granulomas can go away on their own with minimal consequences and with drug treatment.

The most widely used surgical treatment methods are for dental granuloma and some superficial granulomas ( pyogenic, etc.). In these cases, the infection that caused the disease is local in nature. During the operation, you can completely remove and “clean” the lesion, speeding up recovery. In general, surgery is recommended in all cases of pus formation ( as a complication of granuloma).

In addition to superficial granulomas, sometimes a decision is made to remove reparative bone granulomas and cholesterol granulomas. However, in each specific case, the doctor must see the immediate danger posed by the disease. Otherwise, the risk of the operation will be unjustified.

Delete ( resection, excision) granulomas

The most common surgical procedure is to remove dental granulomas. In this case, there are several treatment tactics. They depend mainly on the location of the granuloma, its size and the presence of other complications. In some cases, the tooth can be saved.

The most common surgical options for treating dental granuloma are:

removal of apical granuloma from under the root with dissection of the gums;
removal of the granuloma along with the apex of the tooth root;
removal of the entire tooth ( if there is serious damage to the root that will not allow the tooth to recover after surgery);
hemisection of the tooth ( partial removal);
filling the granuloma cavity with various cementing mixtures;
opening and draining cavities without completely removing them.

Of course, each type of operation has its own indications and contraindications. The feasibility of their implementation is determined by the dentist after examining the patient and conducting the necessary examinations ( usually plain radiography). In most cases, correctly removed dental granuloma does not recur.

Superficial granulomas of the skin, soft tissues and mucous membranes are usually removed with local anesthesia. The possibility of removing granulomas is assessed only after a final diagnosis has been made.

Under no circumstances should you try to remove even a small granuloma at home!
Firstly, the risk of infection is high. Secondly, some granulomas require a special technique ( for example, vascular granulomas bleed heavily when removed). Thirdly, it is advisable to send the removed granuloma after removal for histological analysis to exclude malignant neoplasms and confirm the diagnosis. In all cases of surgical removal of granulomas, a course of drug treatment is also necessary.

Laser treatment of granuloma

Currently, laser surgery is actively developing. Laser radiation allows for targeted destruction of certain formations without damaging surrounding tissue. This treatment option may be used for some types of granulomas. First of all, we are talking about superficial vascular granulomas, which often represent a purely cosmetic defect. It is convenient to remove them with a laser, since the tissue “dries out” and there is no bleeding, which often complicates removal using a conservative method.

There are also currently options for removing dental granulomas using a laser. This requires special expensive equipment, so the prices for such an operation are much higher.

In the case when we are talking about volumetric formations ( more than 1.5 - 2 cm in diameter) or pus formation, simple surgery without the use of a laser would be preferable.

Cauterization of granuloma

The technique of cauterizing granulomas has not been used in medicine for a long time. In the case of granulomas, this is, firstly, ineffective, since cauterization does not eliminate the cause of its formation. Secondly, it is simply painful, 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 cauterizes the cut site.

Currently, cauterization is often understood not as a surgical intervention, but as a drug treatment option. The high temperature during classical cauterization causes instant “drying” of the tissue, blood clotting and the destruction of microbes. As a result, a reliable scar is formed. With granuloma, such a crude approach is not always necessary. The site where the granuloma is removed is often cauterized to speed up healing. However, concentrated solutions are used for this. They chemically produce the same effect as hot metal, but without the intense pain and rough scars.

How long does surgery to remove a granuloma take?

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

The main factor influencing the operation time is the localization of the granuloma. For example, removal of a dental granuloma can last only 30 – 40 minutes ( taking into account pain relief), and maybe several hours ( including complications, tooth extraction and prosthetics if necessary). Some skin granulomas are removed with laser surgery in minutes. If we are talking about removing a granuloma of the liver or brain, then a team of surgeons, full anesthesia and long hours of painstaking work during the operation itself are required. In each specific case, the approximate time of the operation can be obtained from the attending physician ( usually with a surgeon, if we are talking about removal).

Will there be a scar after granuloma removal?

Scars after surgery are a consequence of the growth of connective tissue fibers. In this way, the body restores its integrity and restores strength to damaged tissues. Therefore, a scar, more or less noticeable, will remain after any major operation. Since when removing a relatively large granuloma we are talking about removing a certain amount of tissue, the scar will remain. However, how noticeable it will be largely depends on the technique of performing the operation.

After removal of granulomas on the skin with a laser, there may be no scar left, but sometimes depigmented ( light) or pigmented ( dark) speck. Surgical removal usually leaves a scar or scar, but if the tissue was carefully sutured with an intradermal suture, the mark is almost invisible ( narrow strip about 1 mm thick).

It should be noted that for some infections ( for example, with syphilis) tissues are damaged during the formation of granuloma. Then the scar will remain and can be very noticeable. However, in such cases, the question of surgical removal of granulomas usually does not arise.

What other treatment methods are there to remove granuloma?

In principle, most granulomas are treated with medication. Surgical removal of such formations is rarely required. Other methods ( folk remedies) will be ineffective for most pathologies. If you turn to cosmetology and plastic surgery, then there are more treatment options. For example, along with laser removal, freezing of the granuloma with subsequent destruction is practiced. However, these methods are used only for skin granulomas and not for all pathologies. In each individual case, you can consult with a specialist who will tell you what treatment options exist for a particular patient.

Is it possible to cure granuloma with folk remedies?

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

For dental granuloma with severe symptoms ( pain, inflammation, infection) you can use the following folk remedies:

Propolis infusion. 30 g of propolis are infused in a full glass of vodka for a week. After this, if pain occurs ( including against the background of granuloma) you can moisten a cotton swab in the infusion and apply it to the base of the diseased tooth or to the gum in the corresponding granuloma area.
Garlic infusion. Garlic is also infused with vodka, after finely chopping it. The standard proportion is 1 to 5 ( 100 g garlic per 0.5 liter of vodka). Infusion should last for at least 10 days with daily shaking or stirring of the contents. After this, lightly rinse the mouth in the area of the diseased tooth with the resulting infusion. Non-drinkers or children can dilute the infusion with boiled water in a 1 to 1 ratio.
Onion juice. Freshly squeezed onion juice can also be used for intense and prolonged toothache. To do this, soak a cotton wool or rolled gauze in it and place it behind the cheek until the pain subsides.
Potato juice. In case of inflammation of the tooth granuloma, leakage of pus or pain, you can drink juice from raw potatoes, while rinsing the sore tooth. However, this remedy is not very beneficial for tooth enamel and, if used regularly, can cause caries. After rinsing with juice, it is recommended to thoroughly rinse your mouth again with warm boiled water.

There are other folk remedies to relieve the symptoms of dental granuloma. However, in general, they are not suitable for the full treatment of the disease, since the granuloma itself will not resolve with their use. They are sometimes useful as a temporary remedy until you see a specialist and have the problem removed.

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 causative agent of the disease, but reduce inflammation, strengthen the immune system and slow down the development of infection. Their use will only be beneficial in combination with the necessary anti-tuberculosis drugs.

If a tuberculous granuloma is detected, the following folk remedies can help:

Garlic. Garlic has a strong antimicrobial effect. Its regular consumption can slow down the development of tuberculosis bacilli.
Milk with additives. Patients with tuberculosis should not fast, 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.
Aloe infusion. An infusion is prepared from young aloe leaves. They are cut into small pieces and the juice is squeezed out. Add 200 g of honey and 300 g of dessert wine to 100 ml of juice. Infusion lasts for at least 3 days in the refrigerator.
Motherwort decoction. Motherwort leaves are washed, dried and brewed as tea. It is advisable to pour boiling water over it and cook for another 5 – 10 minutes.

In general, there are quite a few different folk recipes that are recommended for use for various granulomas. However, the effectiveness of these agents is limited in most cases. Before using them, it is recommended to consult with your doctor. Often, experts can, among other things, recommend good preparations based on medicinal plants.

Granuloma treatment price

Prices for the treatment of granulomas can vary widely. This depends, of course, on the disease that caused the appearance of this formation, and on the clinic to which the patient goes. In most cases, treatment will be relatively inexpensive. More money will be required for full diagnostics.

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

Dental granulomas are treated in most public dental clinics either through health insurance or for a reasonable fee ( up to 5 – 10 thousand rubles). However, deeply located 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 that expensive. Treatment of advanced tuberculosis requires a lot of money, since in this case the drugs are quite expensive, and the entire course of treatment can last 1–2 years. However, there are many government programs and international funds to combat this disease, which provide free treatment or financial assistance.
Treatment of granulomas in autoimmune diseases can be significantly more expensive, since active drug treatment with expensive drugs is required. As a rule, the course of treatment in these cases lasts a long time ( months, sometimes years).
Surgical removal of granulomas ( if necessary) can be very expensive. This depends, first of all, on the location of the formations.

It 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 reaction. Most often, granuloma annulare develops against the background of:

Genetic predisposition;
Carrying out tuberculin tests;
Injuries;
Bites from ticks and other insects;
Sunburn;
Autoimmune;
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.

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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 a gelatin-like substance is secreted from time to time 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 a 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:

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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.

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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.

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The causes of granuloma annulare are under study; among scientists there are several opinions on this matter.

One assumption is based on a malfunctioning immune system. It is believed that hypersensitivity contributes to the development of the disease. The relationship of some chronic diseases with the appearance of granuloma, such as tuberculosis and sarcoidosis, has also been noted. Also, this may even be a consequence of some kind of allergic reaction of the body.

Sometimes the appearance of granuloma annulare was noted after an insect bite - a tick, a wasp, or after a sunburn. Some experts see a connection between a hereditary factor and the onset of the disease. Granuloma can also appear at the site of scars, tattoos, or in places where there was shingles.

The fact that diabetes mellitus can cause the appearance of granulomas still remains the main topic of debate on this matter. For example, in adults a relationship was found between these two diseases, while in children no such connection was visible.

Symptoms of granuloma annulare

At the onset of the disease, pink, red, bluish or flesh-colored papules appear. The skin on the formations is smooth, dense and shiny. The patient does not experience any special sensations; usually no discomfort is felt. The papules themselves spread throughout the body over several months, the plaque grows in diameter and can reach ten centimeters.

Granuloma annulare is divided into two main types: the typical form and the atypical form of the disease. These two groups are further subdivided into several types.

In the typical form of the disease, papules are few in number and localized on the bends of the limbs. Granulomas form a ring in which the central part of the skin is not affected by the disease. The papules are not large, up to five centimeters in diameter. It is very rare, but it happens that granulomas form inside each other. Typical papules usually go away on their own, with relapses occurring very rarely.

Disseminated atypical granuloma annulare affects about 15% of people. This type of disease affects mainly older people, very rarely. Papules form throughout the body, most often on the back, abdomen and limbs. This type of disease lasts a long time and is difficult to treat.

The subcutaneous form of atypical granuloma affects mainly children under the age of six. Multiple subcutaneous nodules appear that spread to the elbows, fingers and head. Very often granuloma appears on the upper eyelid.

The least common form of perforating granuloma annulare is observed in 5% of patients. The disease affects the hands and fingers. Papules may contain a plug in which gelatinous contents form. From time to time this fluid is released and then crusts form.

Treatment of granuloma

Granuloma annulare is a disease that does not require any special treatment. Most often, the plaques gradually go away on their own. Sometimes a doctor may find it necessary to prescribe hormonal medications to treat granuloma.

Due to damage to the skin, granuloma annulare often occurs in children. For example, after a harmless scratch, wound, or abrasion left by a cat, especially poorly treated, during teenage puberty. According to dermatologists, the disease can also be caused by external agents - bacteria, unsuccessful dental treatment.

Granulomas sometimes appear after a foreign body or substance gets on the damaged surface of the skin, for example, chemical paints and dyes, talc (from medical gloves), silicone, paraffin (if you have joint prostheses), zirconium (when using deodorant).

Granuloma in adults, in addition to the listed reasons, can appear against the background of systemic diseases, namely: sarcoidosis, tuberculosis, diabetes mellitus, lupus erythematosus. Thus, granulomatous diseases form a large group of dermatoses, characterized by the formation of granulomas with the body’s immune response.

Granulomas are plaques or nodules that appear anywhere on the body on the skin, most often on the legs - multiple or single. The first case speaks of granulomatosis. Immune cells cluster around such damage and lead to the formation of inflammatory infiltrates. They do not cause much concern, since there is often no pain or itching.

At first, a person does not pay attention to the rashes at all - they appeared and appeared. People begin to worry when granulomas increase in size, do not go away for a long time and damage new areas.

Granulomas can remain on the body from several months to several years, disappear and reappear without causing objective sensations. As a result of successful treatment, granuloma annulare leaves a mark on the skin that becomes invisible over time.

It is best to consult a dermatologist in a timely manner without self-medicating, which can hide the picture of the disease. The doctor prescribes treatment and, if necessary, additional examination to find out the cause of the disease.

To treat granulomas, hormonal ointments (celestoderm, dermovate, triderm) are used, usually applied under a bandage. These drugs are strong, so they are selected by a doctor and used in certain courses strictly as prescribed. In severe cases, it is possible to prescribe certain antimalarial drugs internally, which are also effective for granulomatosis.

If granulomas are difficult to treat or have a pronounced cosmetic defect, they are removed in the clinic using special methods. In this case, to determine the nature of the dermatosis, a histological examination is carried out. If granuloma annulare is a consequence of any systemic diseases, then it is important to take your health seriously. And then, against the background of proper treatment of the underlying disease, the rashes will begin to disappear.

What should not be done for granuloma annulare?

Do not pick the rash, steam it, try to squeeze it out, or rub it with a brush or hard washcloth. They should not be dried under the sun or irradiated with a blue lamp or similar devices. Physiotherapy will also not be beneficial. It has its own specifics and can only be performed by modern dermatological clinics.

For prevention, treat the area of damaged skin with iodine as quickly as possible, then lubricate it 2-3 times a day with brilliant green. When working in the beds, be sure to wear socks so that bacteria and germs do not get into the small cracks of the soles of your feet along with the soil. Granuloma can often appear on the gum after visiting the dentist. In this case, rinsing the mouth after meals and before bed with an infusion of oak bark, chamomile, and sage will help. In all other cases of granuloma formation, various baths, rubdowns, lotions and other water procedures will not have an effect. Infusions are prepared as follows: pour 0.5 liters of boiling water with 2-3 tbsp. raw materials, leave for 30-40 minutes (pour oak bark infusion in a thermos in the evening), strain.

Since granuloma annulare is associated with the immune response to skin rashes, it is advisable to strengthen the immune system. For example, echinacea tablets: children under 12 years old and adults - 1 tablet. 3-4 times a day. Keep in mouth until completely dissolved. Course - 1 month. You should not take the drug for longer. It is contraindicated in children under 12 years of age and patients with widespread.

Folk remedies will also help boost immunity

1. Mix 1 tbsp. chopped elecampane root with 5 tbsp. rose hips. Pour 1 liter of boiling water over the raw material, simmer over low heat for 15-20 minutes, remove, leave for 1 hour. Use the decoction by pouring boiling water over it as an additional infusion for tea.
2. Take 0.5 cups of radish juice and carrot juice, mix, add 1 tbsp. lemon juice and honey. Drink 3-4 times a day, 1 tbsp. before food.

An active and healthy lifestyle, hardening the body from childhood, playing sports and swimming are important.

Treatment of granuloma annulare is successful in 60-80% of cases within 1.5-2 years. Keep this in mind so that you can be patient for successful treatment. Relapses occur, but resolve faster than the initial rash. For prevention, use the above recommendations. They are simple and, as they say, for every day.

In the practice of dermatologists, skin diseases, including chronic skin diseases, have become increasingly common, which is a big and serious problem in many countries. Today we will look at the disease - granuloma annulare. This disease is chronic, in which nodular rashes appear in the form of a ring. Today, doctors cannot accurately name the causes of this type of granuloma. It is believed that such rashes may be the result of diabetes mellitus, or an existing disorder of carbohydrate metabolism, or excessive consumption of refined oil, or due to mechanical trauma to the skin.

Anyone can get this disease. But with an unclear etiology, the worst thing is that a person simply will not know what to fear and how to treat. Granuloma annulare most often affects children aged 3-10 years, as well as adult women.

Diagnosis of the disease. Granuloma annulare is identified using a histological examination, in which destruction of elastic fibers, existing changes in the blood vessels of the middle part of the dermis, as well as small foci of connective tissue necrobiosis and other factors are visible.

Clinical manifestations of granuloma annulare:

The most important sign of this disease is small nodules with a diameter of about four millimeters, flesh-colored or pinkish-brown.

These nodules stop and form a kind of rings; these rashes do not peel off.

They are located in different places of the body, for example, on the feet, bends of the elbow joints.

Granuloma annulare comes in three forms: localized, widespread form and toxic erythema.

With a localized form For this disease, the rash can appear only in one specific place. For widespread granuloma multiple rashes appear on several areas of the skin. Erythema toxicum can be observed mainly in children, resembling a localized form of the disease. If such rashes appear on your body or on your baby’s body, you must immediately seek help from a specialist dermatologist to make a diagnosis and prescribe the necessary course of treatment.

Classic localized granuloma annulare may resolve spontaneously. Relapses can occur quite often, and the rashes can resolve faster than primary lesions, for example, within 2 years. To treat disseminated forms, longer treatment is required, since they are often resistant to treatment.

Treatment of granuloma. The course of treatment for this disease includes following a special diet, as well as the use of the following medications: Doxium, Teonicol, Trental, Vitamin E, Dipromonium and some others. To treat this form of the disease, special ointments are used. You can be treated, for example, Flucinar or Prednisolone ointment . Vitamin complexes are also prescribed.

Because granuloma annulare often resolves spontaneously, watchful waiting may be considered. Of course it is possible, apply radio-, cryo-, laser and PUVA therapy, Niacinamide, Isotretinoin, Salicylates, Potassium iodide, Dapsone, antimalarial drugs and Chlorambucil. But treatment is often ineffective. Treatment is currently being carried out high potency topical steroids , which are used in the form of an occlusive dressing or injections into the lesions. This therapy usually stops the development of granuloma annulare, but may cause secondary skin atrophy.

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