Dear Dr. Roach: I am 58 and have been diagnosed with granuloma annulare, which I鈥檝e had for more than a year and a half. I have both rings (that start small, like a cigarette burn, and then get larger) and spots, which look like birthmarks. They are unsightly. I am told that there is no remedy for this. I tried changing my diet to no avail. I鈥檝e been using a topical cream, clobetasol, which doesn鈥檛 seem to help. My research tells me that it usually goes away after two years, but I also have seen several cases where it never goes away. Please give me some good news!
D.R.
The good news is that they usually do go away (50 per cent within two years). They don鈥檛 turn into skin cancer and, generally, don鈥檛 cause a lot of problems other than being unsightly. Some studies have associated granuloma annulare (GA) with conditions such as diabetes and cancer, but it鈥檚 not certain..
The skin cream you are using works for many people, but an injection of a steroid is more effective 鈥� it鈥檚 successful in about 80 per cent of people. These can be repeated in six to eight weeks if needed.
The spots also can be frozen with liquid nitrogen, but this can leave scarring. Ultraviolet light has been shown to be helpful.
听
Dear Dr. Roach: I am an 84-year-old woman in good health. I had been diagnosed with possible lupus since 1996, because of a high sedimentation rate in my blood. Since I had no symptoms of this autoimmune disease, my blood samples were sent to a lab. It came up with the diagnosis of Sjogren鈥檚 syndrome. I have minimal dry eyes and dry mouth. Is there a chance that the abnormal lab results could be wrong?
E.R.
Blood tests are useful in making diagnoses, but in the case of both lupus (I mean systemic lupus erythematosus) and Sjogren鈥檚 syndrome, diagnosis can鈥檛 be made by lab tests alone. The sedimentation rate, or ESR, usually is high in rheumatologic diseases, but it can also be high due to infection, autoimmune disease or malignancy. Older women have higher levels normally. A high ESR alone is not diagnostic of any specific condition.
SLE is a disease of the body鈥檚 immune system, where multiple systems are attacked. The diagnosis of lupus is made by a combination of symptoms 鈥� such as rash, arthritis, neurologic problems or kidney disease. Blood-test abnormalities alone rarely make the diagnosis. Occasionally, a blood test will turn positive before other symptoms develop.
Sjogren鈥檚 syndrome is diagnosed if there are symptoms of abnormal tear and saliva production, and biopsy and lab tests of Sjogren鈥檚 antibodies. If you have the Sjogren鈥檚 antibodies and have symptoms of eye and mouth dryness, a definitive diagnosis of Sjogren鈥檚 would still require an abnormal eye exam, salivary-gland biopsy or saliva tests.
Most conditions and diseases range in severity from unnoticeable to life-threatening. It鈥檚 possible you have a relatively mild form of Sjogren鈥檚 that isn鈥檛 going to get any worse.
