Generalized granuloma annulare successfully treated with apremilast: report of two cases and literature review

Hansel, Katharina; Biondi, Filippo; Bianchi, Leonardo; Tramontana, Marta; Marietti, Rossella; Stingeni, Luca

doi:10.1111/ced.14806

Cited by 7 publications

(7 citation statements)

References 5 publications

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“…Unfortunately, a significant limitation was the very small group of patients treated with tofacitinib [15,16]. Individual case reports show the effectiveness of the treatment of disseminated granuloma annulare with apremilast (a phosphodiesterase 4 inhibitor), although there is still no clear evidence to consider apremilast as an effective therapeutic option for granuloma annulare [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…Niestety znaczącym ograniczeniem była bardzo mała grupa pacjentów leczonych tofacytynibem [15,16]. Pojedyncze opisy przypadków klinicznych przedstawiają skuteczność leczenia rozsianej postaci ziarniniaka obrączkowatego z zastosowaniem apremilastu (inhibitora fosfodiesterazy 4), nadal jednak brakuje jednoznacznych dowodów pozwalających uznać ten lek za skuteczną opcję terapeutyczną dla ziarniniaka obrączkowatego [17,18].…”

Section: Discussionunclassified

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Granuloma annulare – diagnostic challenges

Cichoń¹,

Placek²

2022

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Introduction: Granuloma annulare is a chronic, inflammatory skin disease occurring mainly in young people, much more often in women. Skin lesions may be solitary or diffuse. They are usually located on the backs of the hands or feet and around the ankles. The etiology of the disease remains unknown. A relationship between granuloma annulare and the occurrence of type 2 diabetes, hyperlipidemia or autoimmune diseases is postulated. Case report: We present the case of a 55-year-old woman with bilateral skin lesions on extensor parts of her elbows, who for over 15 years remained without an accurate diagnosis. Clinically, the lesions corresponded to persistent and haughty erythema. Finally, on the basis of histological examination, granuloma annulare was diagnosed. Conclusions: In special cases, granuloma annulare may be a dermatosis that is difficult to diagnose solely on the basis of the clinical presentation. A histological examination are then necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionunclassified

Granuloma annulare – diagnostic challenges

Cichoń¹,

Placek²

2022

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“…vely, with tolerable side-eff ects. 27 However, in a pa! ent of DGA and plaque psoriasis treated by Joshi TP et al, clinical improvement in lesions were seen a# er 3 months of Apremilast 30mg twice a day monotherapy, with near complete resolu!…”

Section: Disseminated Granuloma Annulare (Dga)mentioning

confidence: 99%

“…ng as a down-regulator of Th1 cytokines, has been used as a treatment modality in DGA. 27 Bishnoi A et al, treated 4 pa! ents with Apremilast 30mg twice a day, with clinical response seen in 6-8 weeks and near complete resolu!…”

Section: Disseminated Granuloma Annulare (Dga)mentioning

confidence: 99%

Non-FDA-Approved Uses of Apremilast in Dermatology: A Review of Current Available literature

Bhatia¹

2022

Nepal J Dermatol Venereol & Leprol

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Introduction: Apremilast, an oral phosphodiesterase-4 inhibitor, decreases the production of pro-inflammatory cytokines including tumour necrosis factor-α, interleukin-12/23, IL-12, IL-2, and interferon-γ; while upregulating the anti-inflammatory cytokine IL-10. Its pan-immunomodulatory nature has led to its use in managing various immune-mediated dermatoses for non-FDA-approved indications. Objectives: To review and analyze the use of Apremilast in Non-FDA-approved indications in current available literature. Materials and methods: PubMed, EMBASE, SCOPUS, and Google scholar databases were searched with the parameters “Apremilast”, “Apremilast NOT Psoriasis*”, “Apremilast NOT Behçet’s*”, and “Apremilast NOT arthritis*”. A total of 45 relevant articles were chosen for review. Results: We found 22 indications in dermatology where apremilast has been used without FDA approval. The best evidence was for treatment in Atopic Dermatitis, Alopecia Areata, and Hidradenitis Suppurativa, with randomized controlled trials. Prospective open-label trials were found for Cutaneous Sarcoidosis, Lichen Planus, Rosacea, and Vitiligo. Individual case series and reports were found for Acrodermatitis Continua of Hallopeau, Dermatomyositis, Disseminated Granuloma Annulare, Erythema Nodosum Leprosum, Morphea, Pityriasis Rubra Pilaris, Hailey-Hailey Disease, Recurrent Erythema Multiforme, and Folliculitis Decalvans, Prurigo Nodularis, Perforating Dermatoses, Chronic Actinic Dermatitis, and Hand Eczema, and Epidermolysis Bullosa Simplex-Generalised Severe Type. Apremilast has shown varied efficacy despite a better safety profile and tolerability over a long duration compared to conventional immunosuppressant drugs and placebo. Conclusion: Apremilast has been used for varied non-FDA-approved indications in dermatology with variable efficacy. Better controlled, randomized studies with adequate sample size and drug comparisons are needed for better analyses.

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“…Efficacy of apremilast in generalized GA has been documented in several small case series and case reports (Table 9). [41][42][43][44] Larger placebo-controlled trials are required to establish the role of apremilast in generalized GA.…”

Section: Generalized Granuloma Annularementioning

confidence: 99%

Evolving utility of apremilast in dermatological disorders for off-label indications

Mehta

Sharma

Dogra

2022

Clinical and Experimental Dermatology

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Apremilast, a small molecule that acts by inhibition of the phosphodiesterase‐4 enzyme, has been approved by the US Food and Drug Administration for the management of psoriatic arthritis, plaque psoriasis and Behçet disease. The drug has drawn much interest from practising dermatologists in view of its exceptional safety profile and prescription convenience, as evident by the recent surge of literature describing its off‐label indications. This review was carried out with the aim of summarizing the literature on off‐label use of apremilast in dermatology, in order to guide clinicians regarding currently available evidence. The PubMed database was searched using ‘apremilast’ as a keyword in the title. Abstracts were individually screened to determine whether there was a description of an off‐label use of apremilast in dermatology within the article. Randomized controlled trial data were available for vitiligo, alopecia areata, hidradenitis suppurativa and atopic dermatitis. Case series and case reports describing apremilast were also reviewed. Owing to its broad spectrum of immunomodulatory activity, apremilast may be useful in several chronic inflammatory skin diseases recalcitrant to conventional therapies, either alone or in combination with other drugs. Further studies are needed to establish its role in various dermatological indications.

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Generalized granuloma annulare successfully treated with apremilast: report of two cases and literature review

Cited by 7 publications

References 5 publications

Granuloma annulare – diagnostic challenges

Granuloma annulare – diagnostic challenges

Non-FDA-Approved Uses of Apremilast in Dermatology: A Review of Current Available literature

Evolving utility of apremilast in dermatological disorders for off-label indications

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