I have both MCAD and granuloma annulare, a somewhat rare, inflammatory skin disease which manifests as ring-worm looking rashes on my body.
My son, who also has MCAS, gets the GA bumps that itch on his hands whenever he is sick. So naturally I was curious if our mast cell disease is contributing to these granuloma annulare outbreaks. I was pretty sure it was, but I wanted confirmation (and I found it!).
I’ve written about this aspect of my MCAD journey quite a bit in the past but I wanted to address the topic again right here, on my shiny new website, because I definitely think there is a connection between these two diseases and I want to get this information out there to as many people as possible.
Please remember this is not medical advice, just my own personal experiences with mast cell disease. If you think you have mast cell or any other disease, please see a doctor.
My very first granuloma annulare rash appeared back in September of 2014, a few weeks after I began using a natural estrogen cream. I had no idea I had mast cell disease back then and was trying to treat what I thought was endometriosis pain by using natural hormone creams.
When my first GA ring appeared on my upper inner arm, I was convinced I had ringworm. I tried every remedy I could find to get rid of it but nothing worked. It wasn’t until I stopped using the estrogen cream and stopped triggering my mast cell disease that the first one magically cleared up.
It wouldn’t be long though before another one popped up, this time on my upper thigh. At first it looked like a bruise, then it turned into a patch of what looked like little blisters, just like the first one:
I still didn’t know what it was, but I was being worked up for mastocytosis at that point and I couldn’t help but wonder if this was related even though my immunologist wasn’t sure at the time. All he knew to look for were urticaria pigmentosa lesions, which I did have what appeared to be one on my labia (of all places).
This ring rash was different, though. It didn’t itch like mad when I flared from degranulation like the discolored patch did “down there”. It just kept getting bigger and bigger too, spreading out into a ring,
I had finally found a possible name for it after Googling all the possibilities, and by now I suspected it was a granuloma annulare but I still didn’t know why I had it or how it could be connected to my mast cells.
So I made an appointment with the dermatologist to have it biopsied and ask his opinion. He punched it and tested it and it did, indeed, come back as a granuloma annulare.
In the meantime, my immunologist and I were working together to find the right combination of mast cell stabilizing medicines and as we found them and I found relief from the degranulation symptoms, my granuloma ring gradually disappeared.
It reappeared again when I got sick and looked like this:
Coincidence? I don’t think so.
In fact, I emailed several of the top docs in the mast cell field and two of them wrote back to say that they had never seen the two (MCAD and GA) present in any of their patients at the same time, but I did happen to find Dr. Afrin’s (my hero) video presentation where he describes GA as one of the things doctors may see but not realize it is possibly linked to MCAD.
He calls this disease “the elephant in the living room”, which makes sense. If you click the video below, it will take you to the part where he talks about this (he does not mention GA by name, but it is on his graphic which I screen captured and posted above):
I had dug even deeper and found a VERY interesting connection between MCAD and GA. My first clue was when I found this from the website Patient.info:
It (granuloma annulare) is thought to be due to a delayed hypersensitivity reaction to some part of the dermis with inflammation mediated by tumour necrosis factor alpha (TNF alpha)
That piqued my interest because I had already learned that mast cells, when they degranulate, can release tumor necrosis factor (TNF):
Mast cell secretory granules contain preformed mediators that are rapidly (within seconds to minutes) released into the extracellular environment upon cell stimulation. These mediators include histamine, neutral proteases, proteoglycans, and some cytokines, such as TNF-alpha (TNF-α).
So it seems to me that the release of TNF-a in my body is forming these granuloma rings.
Now, again, this may be a coincidence, but I highly doubt it. The fact is, my granuloma annulare rash will completely disappear when I’m stabilized on my medications for mast cell disease and it will reappear whenever my mast cells degranulate enough to make me sick, like this last week. It can pop up and go down again in a matter of hours, too.
My son has the exact same thing happening with his, except his typically always itch and he knows when they show up he’s degranulating (as if we don’t already know haha). So it’s pretty obvious there’s a connection.
Mine has begun to get itchy at times when it reappears, but nothing like the lesion I had “down there” which itched like crazy before it disappeared completely once I was on the right medications. I had that lesion biopsied, too, but it came back as “normal” so not a UP, although they did say it was made up of “an elevated number of mast cells” and it needed to be followed up on with a mast cell specialist. Hmm.
My goal now is to keep this granuloma annulare rash suppressed using MCAD medications and trigger avoidance because it seems to be the only thing that works to keep it at bay.
** edited to add: I was recently prescribed clobetasol propionate and it worked! Within a few days! I stopped using it though because of the potential MCAS triggering ingredients. 🙁
So, in conclusion, I fully believe my MCAD contributes to my GA and it would take a lot of convincing for me to believe otherwise now.
As always, YMMV and good luck!!