Granulomatous Cutaneous Drug Eruptions: A Systematic Review

Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options

“…In January 2021, Shah et al reviewed granulomatous cutaneous drug eruptions and identified a number of iatrogenic causes of GA: allopurinol, amlodipine, anti-TNFα agents (infliximab, adalimumab, etanercept, and thalidomide), botulinum toxin, dabrafenib, desensitization injections, immune checkpoint inhibitors, intranasal calcitonin, gold, immunizations (hepatitis B and anti-tetanus vaccination), levetiracetam, paroxetine, pegylated IFNα, secukinumab, tocilizumab, topiramate, and vemurafenib [ 49 ]. More recently, acetazolamide [ 50 ], apremilast [ 51 ], ixekizumab [ 52 ], mesotherapy [ 53 ], phototherapy [ 54 ], and measles, mumps, and rubella (MMR) [ 55 ], pneumococcal [ 56 ], and VZV [ 57 ] immunizations have also been implicated in instigating GA.…”

“…For a comprehensive list, refer to the systematic review of granulomatous drug eruptions conducted by Shah et al in January 2021 [ 49 ]…”

“…Thus, downregulation of CD183 + cells could explain the role of infliximab in GA. However, this is likely only one piece of the puzzle, as infliximab, along with adalimumab and etanercept, have also been reported to paradoxically induce GA [ 49 ]. Knowledge of the association between anti-TNFα agents and GA, then, still remains incomplete and further molecular studies are needed to elucidate this relationship.…”

“…GA induced by IL-17 and TNFα inhibitors [ 49 ] is more difficult to explain and defies our current understanding of GA pathogenesis; however, we can attempt an explanation by considering the relationship between the Th1 and Th17 arms of the immune system. Studies of autoimmunity in mice have shown that ablating either axis causes an upregulation of the other [ 100 ], leading us to speculate that in some patients, Th1 blockade causes pronounced upregulation of the Th17 axis, and vice versa.…”

Interstitial Granulomatous Dermatitis With No Neutrophilic Infiltrate

“…Interstitial granulomatous drug eruption is caused by specific drugs such as angiotensin-converting enzyme inhibitors, anticonvulsants, antidepressants, antihistamines, anti-tumor necrosis factor agents, beta-blockers, diuretics, herbal medications, immune checkpoint inhibitors, and lipid-lowering agents. 8 Because ITP in our patient was treated with prednisolone with gastric-coating agent and vitamin D3 preparation, the possibility that our patient developed interstitial granulomatous drug eruption was denied. In addition, no interface reaction was detected at the dermoepidermal junction in our case despite the presence of interface dermatitis as a characteristic feature of interstitial granulomatous drug eruption.…”