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Granuloma Annulare - Anyone Else?

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When I first started experiencing ME/CFS symptoms back in 2018, I did not have any notable skin symptoms to speak of outside of mouth ulcers (formally diagnoses as aphtous ulcers). It was the typical fatigue, brain fog, pain, light sensitivity, etc that defined the illness.

However, I had my third "big crash" in 2019 and started experiencing a new symptom - granuloma annulare. These are small red bumps that appear on the backs of my hands, around my knuckles, and on my cuticles. They do not itch, but they can sometimes be lightly painful to the touch (feels like a splinter). They are often clustered together - I will have 5-6 on my knuckles when I'm experiencing moderate to severe crashes. They disappear suddenly after I start recovering from a crash - usually alongside valacyclovir/azithromycin treatment.

My rheumatologist and infectious disease doctors do not know what these are - instead they referred me to a dermatologist, but I have to wait 6+ months to get in to see one.

Pictures below - does anyone else experience this symptom?

EDIT: Just to add some research I've done - granuloma annulare is currently understood to be a rare condition with an unknown origin (of course). Thyroid dysfunction, hyperlipidemia, viral infections, and autoimmune conditions are comorbid with this condition (again, of course it is). I just got a lipid panel, thyroid panel, and hormone panel done this morning to check to see if everything is OK - my thyroid has been always come back relatively clean, but my lipids have been trending into the "hyperlipidemia" range since being diagnosed with ME/CFS.

Picture 1: Picture 2:
 
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ljimbo423

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They are often clustered together - I will have 5-6 on my knuckles when I'm experiencing moderate to severe crashes.
Pictures below - does anyone else experience this symptom?

I get them too, in the same places. I usually get mine from bacterial die-off from my gut or when I'm experiencing some PEM, even it's it's very mild sometimes. I have no idea what they are but they always go away fairly quickly, often within hours or a day or so at most, without treatment.

Mine do itch a little sometimes but not very often. I notice them sometimes because they feel kind of hot and maybe hurt a tiny bit.
 
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I get them too, in the same places. I usually get mine from bacterial die-off from my gut or when I'm experiencing some PEM
Interesting - I've noticed a correlation between gut dysbiosis and the appearance of these granulomas as well. Mine usually last 3-10 days, but yeah, can often feel "hot" and are just mildly painful.

Apparently they are clusters of T cells beneath the skin, according to wikipedia. Again, found most often in autoimmune patients, and in women more than men. It seems normal that corticosteroids are a common treatment for this symptom, however it is a bit weird that an antibiotic cocktail of rifampin (600 mg), ofloxacin (400 mg), and minocycline hydrochloride (100 mg) often clears these up as well. Maybe this symptom is a direct result of gut dysbiosis triggered by ME/CFS - which antibiotics would influence directly - however the antibiotic cocktail mentioned above doesn't have a ton of research when it comes to altering the microbiome.
 

ljimbo423

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Apparently they are clusters of T cells beneath the skin, according to wikipedia.
It does seem to me that they are somehow related to the immune system. I read that link you put up and that sure sounds what I have.

It seems normal that corticosteroids are a common treatment for this symptom, however it is a bit weird that an antibiotic cocktail of rifampin (600 mg), ofloxacin (400 mg), and minocycline hydrochloride (100 mg) often clears these up as well. Maybe this symptom is a direct result of gut dysbiosis triggered by ME/CFS - which antibiotics would influence directly - however the antibiotic cocktail mentioned above doesn't have a ton of research when it comes to altering the microbiome.
I don't think I've tried hydrocortisone cream on them yet, maybe I'll do that the next time I get them. Mine do seem to have a direct connection to my gut microbiome/dysbiosis. The microbiome/dysbiosis is also linked to many autoimmune illnesses. Although I'm not aware of any definitive connection yet.
 

xebex

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I have them too all over my arms and legs, got them about 2 years after my first ME “attack” which I subsequently recovered to 95% from. They started growing around scars that I had had from bike crashes then I got them from bloods being taken and Insect bites. They seem to be some kind of autoimmune issue to do with collagen build up from scarring. Around the granuloma I also have lax skin as if the collagen is degrading. Dermatologist was not interested and as they are pretty benign I do not treat it however I think It is a clue to my issue with vasodilation and wonder if I actually have it/degraded collagen in my bloodvessels. Vasodilation comes and goes but the granuloma is always there and has been for about 8 years. The patches are gradually spreading out allover the skin.
 

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Update: I'm testing a new theory around ME/CFS and underlying endocrine dysfunction, since this skin condition happens most often in those with hyperlipidemia and thyroid disorders. I started taking a small amount of liothyronine (5mcg) once in the morning for the last three days. My relatively recent thyroid test results show a low-normal T3 value, normal T4, normal TSH (2.5), but highly elevated rT3. My granuloma annulare has almost completely disappeared over the last three days, and my gut seems to be back on track. I haven't changed anything else diet or supplement wise. I also have an increased amount of energy, with no hyperthyroid symptoms. All of the inflammatory symptoms I've been experiencing over the last couple weeks (muscle pains, easily fatigued, joint aches, etc) have diminished greatly.

I found this paper that discusses interesting sub-clinical "euthyroid" endocrine disruptions in ME/CFS patients. The author concludes that direct T3 supplementation may be an interesting research avenue, but to the best of my knowledge there has been no follow up study on this topic. He speculates that while serum T3 may appear to be relatively low-normal, that there are metabolic indications that tissue T3 levels may be much lower than what is portrayed in serum. T3 also stimulates different parts of pyruvate metabolism through genetic upregulation of PDC, which may fix some underlying metabolic disturbances short term.

@Hip : have you seen anything regarding direct T3 supplementation in ME/CFS patients?

As a disclaimer, I know that messing with thyroid hormones is a HEAVILY RISKY move. This is a tightly regulated system that will probably overcorrect in the wrong direction if I continue to supplement with liothyronine directly.
 

Hip

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@Hip : have you seen anything regarding direct T3 supplementation in ME/CFS patients?
I've seen the paper you linked to on the low T3 syndrome found in around 1 in 6 ME/CFS patients, so these patients might certainly benefit from T3 supplementation.

T3 supplementation is not that risky. Bodybuilders take quite high doses (eg 50 mcg daily) of T3 for a month or two to burn off body fat, for example.
 

xebex

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I don't think I've tried hydrocortisone cream on them yet, maybe I'll do that the next time I get them. Mine do seem to have a direct connection to my gut microbiome/dysbiosis. The microbiome/dysbiosis is also linked to many autoimmune illnesses. Although I'm not aware of any definitive connection yet.
I decided not to use hydrocortisone mainly because the GA Is all over my arms and legs and the cream would likely cause thinning of the skin, I’d rather have the weird skin than damaged skin. Just as a heads up.
 
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Update: granulomas came back less than a week after starting low-dose T3. I also stopped supplementing with ubiquinol that same week, just because I ran out. I also started experiencing more fatigue, gastro symptoms, etc. On a whim I bought more ubiquinol, started dosing at pretty high concentrations (1000mg/day), and the granulomas are disappearing again. There seems to be some interplay between T3 and ubiquinol concentrations that is interesting. I'm on day 2 of ubiquinol supplementation, but I have enough to continue dosing at this high concentration for a month, so I'll continue updating this thread.