Granuloma Annulare: A Focused Review of Therapeutic Options

Abstract

Granuloma annulare (GA) is a benign inflammatory disease associated with many conditions such as malignancy, trauma, thyroid disease, diabetes mellitus, and HIV infection. Common clinical subtypes include localized GA, generalized GA, subcutaneous GA, perforating GA, and patch GA. There exists an abundance of literature on GA, yet we know relatively little about its exact etiology and even less about its treatment. The paucity of conclusive data on effective treatment options is largely because the majority of published studies are limited to small case reports, case series, and retrospective studies. As such, there does not yet exist a gold standard of care to guide clinical management. Depending on the clinical subtype, the clinical prognosis for GA can vary. The localized variant generally self-resolves within 2 years without treatment, whereas the generalized form is more chronic and less responsive to treatment. This focused up-to-date review serves to summarize the latest therapeutic options available for GA.

Concurrence of generalized perforating and subcutaneous granuloma annulare in a 4‐year‐old boy with latent tuberculosis infection successfully treated with low‐dose hydroxychloroquine

“…1 Hydroxychloroquine, an antimalarial drug, may suppress the immune and inflammatory response in GA, 5 and the present case showed the effectiveness of hydroxychloroquine in treating generalized perforating and subcutaneous GA. Generalized GA is difficult to treat; the lesions cannot resolve spontaneously and topical and systematic treatments are both needed.…”

Granuloma anular subcutáneo

“…Se trata de una entidad de etiología desconocida y autolimitada, pero con recurrencias frecuentes. De entre las variantes de GA descritas, el GA profundo o subcutáneo ocupa el tercer lugar en frecuencia tras el GA localizado y el GA diseminado [1,2]. Característicamente, el GA profundo afecta a niños sanos menores de 5 años, y con menos frecuencia a adultos jóvenes [1][2][3][4][5].…”

“…De entre las variantes de GA descritas, el GA profundo o subcutáneo ocupa el tercer lugar en frecuencia tras el GA localizado y el GA diseminado [1,2]. Característicamente, el GA profundo afecta a niños sanos menores de 5 años, y con menos frecuencia a adultos jóvenes [1][2][3][4][5]. El granuloma anular profundo o subcutáneo se presenta como nódulos indoloros color piel, de predominio en miembros inferiores, manos o cuero cabelludo [1][2][3].…”

Teledermatology management of difficult-to-treat dermatoses in the Faroe Islands

“…The disease may further require surgery to alleviate synechiae complications (8). In contrast, granuloma annulare is a benign self-limiting inflammatory condition without a gold standard for treatment but with a wide array of therapeutic options ranging from photo-therapy and injections to cryosurgery (9). Balanitis is a common disorder with multiple infectious and non-infectious etiologies.…”