Granuloma annulare

Piette, Evan W.; Rosenbach, Misha

doi:10.1016/j.jaad.2015.03.055

Cited by 121 publications

(23 citation statements)

References 206 publications

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“…c-interferon and TNF-a) mount an immune response that leads to granuloma formation. 1,10 Our immunohistochemical results confirm that the cellular infiltrate in GA is mainly composed of myeloid dendritic cells and different macrophage populations (with M1-and M2-like phenotypes). [11][12][13] Myeloid dendritic cells and M1-like macrophages are known to produce TNF-a, which plays a crucial role in the development of granulomas.…”

Section: Discussionsupporting

confidence: 70%

“…GA is predominately mediated by a T‐helper 1 cell‐mediated reaction, in which a complex network of macrophages, dendritic cells, lymphocytes together with an upregulation of various cytokines (i.e. γ‐interferon and TNF‐α) mount an immune response that leads to granuloma formation . Our immunohistochemical results confirm that the cellular infiltrate in GA is mainly composed of myeloid dendritic cells and different macrophage populations (with M1‐ and M2‐like phenotypes) .…”

Section: Discussionsupporting

confidence: 69%

“…Various systemic agents including antimalarials, dapsone, doxycycline, isotretinoin and niacinamide have been used, but none has been found to be uniformly effective. 1,2 Herein, we report a case of disseminated GA which showed a quick and sustained resolution after treatment with infliximab. Additionally, we sought to investigate the immune mechanisms underlying treatment efficacy.…”

Section: Introductionmentioning

confidence: 97%

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Infliximab reduces activated myeloid dendritic cells, different macrophage subsets and CXCR3‐positive cells in granuloma annulare

Bürgler

Vinay

Häfliger

et al. 2019

The Journal of Dermatology

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Disseminated granuloma annulare (GA) is a rare granulomatous dermatitis of unknown etiology. Treatment is often challenging and lack of a uniformly effective treatment, adds to the disease morbidity. Tumor necrosis factor (TNF)‐α is an important cytokine in granuloma formation and previous reports have shown improvement of disseminated GA with anti‐TNF‐α therapy. Nevertheless, the underlying mechanism of actions of TNF‐α inhibitors in GA remains unclear. Our aim was to evaluate alterations in the inflammatory infiltrate in a patient who experienced complete clearance of GA after treatment with infliximab. A skin biopsy was obtained before and 24 weeks after treatment with infliximab 5 mg/kg at weeks 0, 2, 6, 14 and 24. Immunohistochemical stains were performed in pre‐ and post‐treatment biopsy specimens using CD1a, CD4, CD8, CD11c, CD32, CD68, CD69, CD163, CD183 and human leukocyte antigen (HLA)‐DR to characterize alterations of the infiltrates. Parallel with clinical improvement, we observed a marked decrease in myeloid (CD11c) dendritic cells, different macrophage subsets (CD68, CD32, CD163) and T cells. In addition, a marked reduction of activation markers (HLA‐DR, CD69) and CD183+ (CXCR3) cells was observed in post‐treatment biopsy specimens. In conclusion, the clinical improvement of disseminated GA by infliximab is paralleled by inhibition of activated myeloid dendritic cells, different macrophage subsets and type 1 T cells.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 97%

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Infliximab reduces activated myeloid dendritic cells, different macrophage subsets and CXCR3‐positive cells in granuloma annulare

Bürgler

Vinay

Häfliger

et al. 2019

The Journal of Dermatology

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“…In a 2017 retrospective cohort study, 10 of 18 patients (55.6%) treated for granuloma annulare with hydroxychloroquine improved with therapy . While localised granuloma annulare may respond to topical and intralesional therapy, widespread disease is more suited to treatment with antimalarials and phototherapy . Similarly, a 2015 systematic review suggested hydroxychloroquine as a third‐line therapy for granuloma annulare.…”

Section: Clinical Applications In Dermatologymentioning

confidence: 99%

Hydroxychloroquine in dermatology: New perspectives on an old drug

et al. 2019

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Hydroxychloroquine is an age-old drug whose use as an immunomodulatory agent with a low side-effect profile continues to expand. We present a review of this drug including recently updated prescribing recommendations and a summary of its clinical application in dermatology. A maximum daily dose of 5.0 mg/kg based on actual body weight and no greater than 400 mg is advised in order to reduce the risk of retinopathy, which is potentially permanent and has an estimated prevalence of 7.5% at 5 years on standard dosing. Baseline ophthalmologic assessment followed by annual screening after 5 years is recommended; however, closer monitoring should be considered in the setting of existing retinopathy, a cumulative dose > 1000 g or renal dysfunction. Hydroxychloroquine is now considered to be safe in pregnancy, and routine glucose-6-phosphate dehydrogenase (G6PD) deficiency testing is not required. Smoking can significantly decrease its efficacy although the reason is still uncertain. Hydroxychloroquine appears to also demonstrate antineoplastic and cardioprotective benefits.

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“…1 GA commonly occurs in the skin around joints in women in their later reproductive years. 2,3 Diseases that occur more commonly in women have been associated with sex-related immune differences, non-hormonal factors on X and Y chromosomes, and pregnancy related changes in immune and metabolic function. [4][5][6][7][8] Cell biologists have outlined the mechanisms of organelle movement during cell stress.…”

Section: Introductionmentioning

confidence: 99%

Granuloma Annulare in Women: Evaluating the Annular Configuration in the Context of Germline Repair

Reisz¹,

Sandhu²

2018

Women Health Open J

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Granuloma annulare (GA) can be seen in both genders and all age groups, but is most commonly seen in women between the ages of 30-60 years. GA has a striking geometric presentation, with near perfect circles and ovals, a central clear zone and a pinwheel configured peripheral rim. We designed a retrospective case series comparing biometric and pharmaceutical data in middle aged women with and without GA to ascertain correlates of the disease. Women with GA were heavier and took more drugs. The use of statins, proton pump inhibitors and serotonin reuptake inhibitors were seen more commonly among the cases but the differences were not statistically significant. Hormone Replacement Therapy (HRT) was seen more commonly in the control group. We propose that the key features of granuloma annulare (female predominance, annular morphology with central clearing, and abrupt onset in the later reproductive years) may relate to events in the fertility cycle that change with age and could be altered by medications.

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Granuloma annulare

Cited by 121 publications

References 206 publications

Infliximab reduces activated myeloid dendritic cells, different macrophage subsets and CXCR3‐positive cells in granuloma annulare

Infliximab reduces activated myeloid dendritic cells, different macrophage subsets and CXCR3‐positive cells in granuloma annulare

Hydroxychloroquine in dermatology: New perspectives on an old drug

Granuloma Annulare in Women: Evaluating the Annular Configuration in the Context of Germline Repair

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