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The basis of management is to find and correct the underlying cause. Many times cats with EGC will respond to treatment with corticosteroids or to ciclosporin.
The treatment of Majocchi's disease can be difficult because the condition can slowly progress and is chronic in nature. After a period of time, the lesions can reoccur. Even though the condition has improved, there is always the possibility of reoccurrence. There are treatments available to help improve the symptoms, however, there is no absolute cure for the disease. Some of these treatments include the application of topical steroids and lotions and ultraviolet therapy. The use of narrowband UVB and psoralen plus UVA have shown to be effective treatments for some patients with pigmented purpuric dermatoses. Majocchi granuloma also commonly occurs as a result of the use of potent topical steroids on unsuspected tinea. Historically, antifungal therapy has been successful in controlling MG in most instances. Therapies that have been used, included oral potassium iodide, mildly filtered local X-radiation, and topical applications of Asterol as a fungicide in both tincture and ointment forms. In modern medicine, systemic antifungals, such as griseofulvin, ketoconazole, and itraconazole, are the pillars of therapy, as they are safe and effective. The duration of therapy should be at least 4–8 weeks, and treatment should be continued until all lesions are cleared. Currently, no data about relapse rates or the complications of not treating Majocchi granuloma exist.
Incision drainage with proper evacuation of the fluid followed by anti-tubercular medication.
Because granuloma annulare is usually asymptomatic and self-limiting with a course of about 2 years, initial treatment is generally topical steroid creams, followed by oral steroids and finally intradermal injections at the site of each ring. Treatment success varies widely, with most patients finding only brief success with the above-mentioned treatments. New research out of India suggests that the combination of rifampin (600 mg), ofloxacin (400 mg), and minocycline hydrochloride (100 mg) once monthly, or ROM therapy, produces promising results. Most lesions of granuloma annulare disappear in pre-pubertal patients with no treatment within two years while older patients (50+) have rings for upwards of 20 years. The appearance of new rings years later is not uncommon.
Prognosis is usually good, however recurrence may happen with rate up to 16%. Presence of myxoid structures in the pyogenic granuloma may be the main cause of recurrence.
Although pyogenic granulomas are not infectious or malignant, treatment may be considered because of bleeding or ulceration. Frequently, pyogenic granulomas are treated with electrodesiccation (cauterization) and curettage (excision), though laser treatment using pulsed dye laser or CO laser is often effective.
Several reports have demonstrated the efficacy of topical application of the beta-adrenergic antagonist timolol in the treatment of pediatric pyogenic granuloma.
There is usually no treatment if the pyogenic granuloma occurs during pregnancy since the lesion may heal spontaneously. Recurrent bleeding in either oral or nasal lesions may necessitate excision and cauterization sooner, however. If aesthetics are a concern, then treatment may be pursued as well. Usually, only minor surgery may be needed, along with a dental cleaning for oral lesions to remove any calculus or other source of irritation. For nasal lesions, nose-picking should be discouraged.
A dermatologist or general physician usually administers combination therapy of drugs used for tuberculosis, such as Rifampicin, Isoniazid and Pyrazinamide (possibly with either streptomycin or ethambutol).
Treatment usually involves surgical removal of the lesion down to the bone. If there are any adjacent teeth, they are cleaned thoroughly with scaling and root planing (SRP) to remove any possible source of irritation. Recurrence is around 10%.
The exact cause of Majocchi's granuloma is not well established however a dysfunctinoal immune system may be a causative factor. The first form of MG, the superficial perifollicular form occurs predominately on the legs of otherwise healthy young women who repeatedly shave their legs and develop hair follicle occlusions that directly or indirectly disrupt the follicle and allow for passive introduction of the organism into the dermis. Hence, the physical barrier of the skin is important because it prevents the penetration of microorganisms. Physical factors that play a major role in inhibiting dermal invasion include the interaction among keratin production, the rate of epidermal turnover, the degree of hydration and lipid composition of the stratum corneum, CO levels, and the presence or absence of hair. Keratin and/or necrotic material can also be introduced into the dermis with an infectious organism to further enhance the problem. In immunocompromised individuals, the use of topical corticosteroids may lead to a dermatophyte infection due to local immunosuppression.
Recommended regimen is doxycycline 100 mg orally twice a day, alternatively azithromycin 1 g orally once per week or ciprofloxacin 750 mg orally twice a day or erythromycin base 500 mg orally four times a day or trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet orally twice a day. All antibiotic regimens should last for at least 3 weeks and until all lesions have completely healed. Normally, the infection will begin to subside within a week of treatment, but the full treatment period must be followed to minimize the possibility of relapse.
According to the CDC 2015 guidelines Azithromycin is the antibiotic of choice.
The lesion should also be treated.
Class 4 infrared laser treatments have been used with much success, although it may take several treatments to achieve the desired outcome.
Licking can be prevented by the use of Elizabethan collars, battery-enhanced wraps, bandages, anti-licking ointments (which are bad tasting), and anti-lick strips (which are either bad tasting or simply provide a barrier). It is important to catch lesions early and keep the animal from licking them to then reduce inflammation and development of a habit. Topical medications such as corticosteroids or DMSO may be effective if used early.
Small lesions may be injected with triamcinolone or methylprednisolone. Oral antibiotics are used to control infection. Surgery may be performed to remove whole lesions, but there is risk of continued self-mutilation to the area afterwards. Other potential treatments include cryosurgery, laser surgery, radiation therapy, and acupuncture. It is important to note that many dogs will lick at another leg, another area on the same leg, or someplace else, creating a new lick granuloma, if they are prevented from licking at the original one while it heals.
Treatment of the primary cause, if known, is essential.
In psychogenic cases, dealing with psychological factors is most important. Factors should be identified such as being left alone all day, being confined, and changes in the household. Correction of these causes may include increased walks, avoiding confinement, and more interaction in the home. Some veterinarians have proposed that diet can affect compulsive behaviors in dogs.
Drugs may be used until behavior modification has had time to take effect. Antidepressants are most commonly used, including doxepin, amitriptyline, fluoxetine, and clomipramine. If the psychological factors are not corrected, the pet will usually relapse after the drugs are discontinued. Endorphin blockers such as naltrexone can be used to reduce addiction to licking, or endorphin substitutes such as hydrocodone may decrease the urge to lick.
The animal should be tested for allergies, and treated accordingly if positive (fatty acids, antihistamines, hypoallergic diet, etc.). It may also be necessary to check thyroid levels, as hypothyroidism seems to play a role in some cases, particularly in black Labrador retrievers; thyroid medication often will resolve the problem if it's due to hypothyroidism.
A foreign-body granuloma occurs when a foreign body (such as a wood splinter, piece of metal, glass etc.) penetrates the body's soft tissue followed by acute inflammation and formation of a granuloma. In some cases the foreign body can be found and removed even years after the precipitating event.
Granuloma is an inflammation found in many diseases. It is a collection of immune cells known as histiocytes (macrophages). Granulomas form when the immune system attempts to wall off substances it perceives as foreign but is unable to eliminate. Such substances include infectious organisms including bacteria and fungi, as well as other materials such as keratin and suture fragments.
Treatment is by surgical excision (complete removal) of the fibrous tissue overgrowth and addressing the causative factor to prevent recurrence of the lesion. Other sources suggest that surgical excision may not be required in all cases. Common techniques for removal of the excess tissue include traditional removal with a surgical scalpel, electrical scalpel, or laser excision with a laser scalpel, e.g. a carbon dioxide laser, , Neodymium-YAG laser, or diode laser. The poorly fitting denture can be adapted to fit better (a "reline") or a new denture constructed. Alternatively, the section of flange that is sharp/over-extended can be smoothed and reduced with a drill.
Treatment for fungal sinusitis can include surgical debridement; helps by slowing progression of disease thus allowing time for recovery additionally we see the options below:
- In the case of invasive fungal sinusitis, echinocandins, voriconazole, and amphoterecin (via IV) may be used
- For allergic fungal sinusitis, systemic corticosteroids like prednisolone, methylprednisolone are added for their anti-inflammatory effect, bronchodilators and expectorants help to clear secretions in the sinuses.
The treatment for CGCG is thorough curettage. A referral is made to an oral surgeon. Recurrence ranges from 15%–20%. In aggressive tumors, three alternatives to surgery are undergoing investigation:
- corticosteroids;
- calcitonin (salmon calcitonin);
- interferon α-2a.
These therapeutic approaches provide positive possible alternatives for large lesions. The long term prognosis of giant-cell granulomas is good and metastases do not develop.
The disease is effectively treated with antibiotics, therefore, developed countries have a very low incidence of donovanosis; about 100 cases reported each year in the United States. However, sexual contacts with individuals in endemic regions dramatically increases the risk of contracting the disease. Avoidance of these sexual contacts, and sexually transmitted disease testing before beginning a sexual relationship, are effective preventative measures for donovanosis.
The treatment of choice is Silver Nitrate. Double-ligature is an alternative treatment for pedunculated granuloma.
In longstanding scarred lesions, squamous cell carcinoma can develop.
Actinic granuloma (also known as "O'Brien granuloma") is a cutaneous condition characterized histologically by a dermal infiltrate of macrophages.
Actinic granuloma is an asymptomatic granulomatous reaction that affects sun-exposed skin, most commonly on the face, neck, and scalp.
It is characterized by annular or polycyclic lesions that slowly expand centrifugally and have an erythematous elevated edge and a hypopigmented, atrophic center.
Advise to reduce exposure to the sun and to use sunscreen.
Treatment with topical halometasone cream, pimecrolimus cream.
The application of corticosteroids to treat contact granulomas is considered a more extreme approach and its utility remains in contention. When employed, it is usually used in conjunction with antibiotics for the reduction of pain and inflammation related to the granuloma. This treatment can be administered orally, through inhalation, or through intralesion injection.
Specific treatment for contact granuloma depends on the underlying cause of the condition, but often initially includes a combination of speech therapy, vocal rest, and antireflux medication. A more aggressive treatment approach could include steroids (inhalant or injection), injections of botulinum toxin, low dose radiotherapy, vocal fold augmentation, or microlaryngeal surgery). Microlaryngeal surgery can be performed either via cold steel excision or various types of laser. The laser is more accurate and typically results in less damage to the surrounding tissue. These more aggressive approaches might be used in the case of the refractory (i.e. resistant to treatment) contact granuloma where previous interventions have not succeeded or recurrence rates are high. The best outcomes appear to occur when a combination of treatments is used.
Annular elastolytic giant-cell granuloma (also known as "Giant cell elastophagocytosis," "Meischer's granuloma," "Miescher's granuloma of the face") is a cutaneous condition characterized histologically by a dermal infiltrate of macrophages.
The affected areas are treated with iodine solutions. A common method to achieve this is to give the cattle sodium iodide orally on a regular treatment schedule. Antibiotics such as Tetracyclines are also used. These two treatment methods can be used alone or together; simultaneous use is considered more aggressive. Killing the bacteria that cause the infection is the ultimately purpose of these treatment methods. However, they are seldom effective unless treatment is started very early.
It is notable that surgery is not typically considered for treatment of cattle as it is in extreme human cases.
Surgical excision or cryosurgery is the treatment of choice. Treatment with antifungals has been considered ineffective, but the use of clofazimine and dapsone in patients with leprosy and lobomycosis has been found to improve the latter. This treatment regimen, with concomitant itraconazole, has been used to prevent recurrence after surgery.