Oral dapsone for the treatment of generalized granuloma annulare: A retrospective case series

Hrin, Matthew L.; Bashyam, Arjun M.; Feldman, Steven R.; Huang, William W.

doi:10.1016/j.jaad.2021.03.045

Cited by 12 publications

(12 citation statements)

References 6 publications

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“…Recent studies of successful and unsuccessful treatments for GA, although limited by size and their observational nature, nevertheless allow us to an opportunity to contemplate GA pathogenesis vis-à-vis treatment. The moderate efficacy of corticosteroids [ 58 , 59 , 81 ] and other anti-inflammatory agents, such as dapsone [ 63 ], methotrexate [ 79 ], pentoxifylline [ 81 ], and sulphasalazine [ 93 ], is consistent with the long-established inflammatory nature of GA. However, not all cases of GA are responsive to global anti-inflammatory therapy, suggesting that the inflammation seen in GA exists along a spectrum: milder and moderate GA can be controlled by topical and intralesional corticosteroids, yet severe cases remain recalcitrant to non-targeted immunosuppression.…”

Section: Does Treatment Recapitulate Pathogenesis?mentioning

confidence: 94%

“…The response to antimicrobials that is seen in some GA patients is most likely due to the anti-inflammatory rather than bactericidal activity of antimicrobials. The moderate response seen to dapsone [ 63 ] and doxycycline [ 43 , 58 ] supports this hypothesis, as both dapsone and doxycycline also have strong anti-inflammatory action.…”

Section: Does Treatment Recapitulate Pathogenesis?mentioning

confidence: 94%

“…However, the remissions were not durable in 57% of responders, who experienced lesion relapse. In addition, subclinical myelosuppression was observed in 31% of patients, warranting discontinuation of treatment [ 63 ]. Two other case series reported similar response rates to dapsone: three of seven patients treated with dapsone experienced partial remission in the study by Visconti et al [ 60 ], and three of five patients treated with dapsone showed improvement in the study by Rubin and Rosenbach [ 58 ].…”

Section: Review Of Management Optionsmentioning

confidence: 99%

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

Joshi

Duvic

2021

Am J Clin Dermatol

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Granuloma annulare (GA) is an inflammatory granulomatous skin disease that can be localized (localized GA) or disseminated (generalized GA), with patch, perforating, and subcutaneous subtypes being less common variants of this benign condition. Recently, new research has emerged that further elucidates GA epidemiology and etiopathogenesis; importantly, new therapeutic options for GA have also been described, although there remains a paucity of randomized controlled studies. In this review, we summarize recent updates on GA epidemiology and etiopathogenesis and offer an updated review of the therapeutic options for GA currently reported in the literature. We hope that the current review galvanizes randomized controlled studies that will in turn help lead to the recommendation of evidence-based treatments for GA.

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Section: Does Treatment Recapitulate Pathogenesis?mentioning

confidence: 94%

Section: Does Treatment Recapitulate Pathogenesis?mentioning

confidence: 94%

Section: Review Of Management Optionsmentioning

confidence: 99%

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

Joshi

Duvic

2021

Am J Clin Dermatol

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“…Chlorambucil, for instance, has been reported in the management of GA [ 6 ] yet it is a very risky treatment as it can precipitate hemorrhagic cystitis. Similarly, dapsone was recently reported to be used for the treatment of GA in 26 patients, and while 54% of patients experienced improvement, 31% of patients experienced myelosuppression, which required treatment to be discontinued [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Apremilast in the Management of Disseminated Granuloma Annulare

Joshi¹,

Tschen²

2021

Cureus

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Granuloma annulare (GA) is a common inflammatory skin condition that manifests as annular skin colored to erythematous papules and plaques. Disseminated GA is a subtype of GA that presents with diffuse cutaneous involvement. While topical and intralesional corticosteroids and phototherapy have been used as therapies for GA, there is no consensus on the best course of treatment for GA. Apremilast is a phosphodiesterase 4 (PDE4) inhibitor that has been Food and Drug Administration (FDA) approved for psoriasis, psoriatic arthritis, and oral ulcers associated with Behcet’s disease; apremilast has also shown promise off-label for other inflammatory skin conditions. Here, we present the case of a woman in whom apremilast use led to an almost complete resolution of her disseminated GA. Our patient tolerated apremilast well and reported no side effects. We also review the literature on the use of apremilast in other patients with GA.

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“…Generalized GA is recalcitrant to therapy [5]. Multiple therapeutic options for generalized GA including hydroxychloroquine [7], PUVA [8], dapsone [9], methotrexate [10], TNF-alpha inhibitor (adalimumab [11] and dupilumab [12]), apremilast [13], and JAK inhibitor (tofacitinib [14]) have been reported to be efective. Around 50% of patients spontaneously resolve within 2 years, and recurrence is also common [2].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Generalized Granuloma Annulare with Oral Griseofulvin

Chumsaengsri

Suwanthaweemeesuk

2022

Case Reports in Dermatological Medicine

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Background. Granuloma annulare (GA) is a benign skin disease that has four clinical variants including localized, generalized, perforating, and subcutaneous GA. The most common type is localized GA, followed by generalized GA. Generalized GA was defined as at least 10 widespread annular plagues and frequently on the trunk, face, neck, and extremities. The diagnosis was made by clinical and histopathology. Generalized GA was difficult to treat. Case Presentation. We presented a Thai woman with nonscaly annular papules and plaques on the trunk and all extremities. A skin biopsy revealed a lesion that was compatible with granuloma annulare. She was partially resolved with 2-month course of oral griseofluvin 500 mg daily. Discussion. The regression of GA response to oral griseofulvin is consistent with the inflammatory nature, which identified IFN-gamma upregulated in GA. Conclusion. Griseofulvin is safe with few side effects and cost effectiveness. Further studies are needed to better understand the immunology and pathogenesis of GA.

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Oral dapsone for the treatment of generalized granuloma annulare: A retrospective case series

Cited by 12 publications

References 6 publications

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

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

Apremilast in the Management of Disseminated Granuloma Annulare

Treatment of Generalized Granuloma Annulare with Oral Griseofulvin

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