Recalcitrant generalized granuloma annulare treated successfully with dupilumab

Song, Eingun James; Bezecny, Joshua; Farrer, Sterling

doi:10.1016/j.jdcr.2020.10.021

Cited by 11 publications

(11 citation statements)

References 6 publications

(10 reference statements)

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“…Recent cases demonstrating response of GA to apremilast [ 69 – 72 ] further indite Th1 axis dysregulation in GA, as apremilast also downregulates TNFα expression. The response of GA to dupilumab, as reported by Song et al [ 76 ] suggests that the Th2 pathway may also be hyperactive in GA, supporting the study by Min et al, which found a marked increase in IL-4 mRNA expression in GA lesional skin compared with non-lesional skin [ 35 ]. However, as the study by Wang et al did not show elevated IL-4 mRNA expression, such an association is tenuous.…”

Section: Does Treatment Recapitulate Pathogenesis?supporting

confidence: 66%

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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?supporting

confidence: 66%

“…Recently, Song reported that dupilumab, an IL-4 and IL-13 inhibitor, could successfully control GA [ 76 ], and also reported that tildrakizumab, an IL-23 inhibitor, was actually ineffective in the management of GA in another patient [ 77 ].…”

Section: Review Of Management Optionsmentioning

confidence: 99%

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

Joshi

Duvic

2021

Am J Clin Dermatol

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“…One case of generalized granuloma annulare refractory to adalimumab showed a sustained partial response [ 267 ], however, emergence of granulomatous drug reactions was also reported under dupilumab therapy.…”

Section: Resultsmentioning

confidence: 99%

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

et al. 2023

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Dupilumab was first approved for the treatment of atopic dermatitis (AD) and blocks the signaling of interleukin (IL)-4 and -13. Several other chronic skin conditions share mechanistic overlaps with AD in their pathophysiology, i.e., are linked to type 2 inflammation. Most recently, dupilumab was approved by the U.S. Food and Drug Administration for prurigo nodularis (PN). Given its relatively good safety profile, effective off-label use of dupilumab has been reported for a multitude of dermatologic diseases and several clinical trials for dermatologic skin conditions are currently ongoing. We conducted a systematic review of applications of dupilumab in dermatology other than AD and PN by searching the databases PubMed/Medline, Scopus, Web of Science and Cochrane Library as well as the clinical trial registry ClinicalTrials.gov. We found several reports for effective treatment of bullous autoimmune diseases, eczema, prurigo, alopecia areata, chronic spontaneous urticaria, Netherton syndrome and a variety of other chronic inflammatory skin diseases.

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“…Studies evaluating dupilumab in granuloma annulare would be particularly informative. To date, the literature is mixed with scarce reports of both improvement in and development of GA with dupilumab 13–15 . Incorporating immune tissue biomarkers as a function of treatment will be key to better understanding this as novel therapeutics for GA such as Janus kinase inhibitors and dupilumab are further evaluated.…”

Section: Discussionmentioning

confidence: 99%

Retrospective assessment of immunologic and histologic heterogeneity in granuloma annulare by cytokine staining

Hwang,

Lee,

Okifo

et al. 2023

Int J Dermatology

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BackgroundType 1 (Th1) and Type 2 (Th2) immunity have both been implicated in granuloma annulare (GA). To what extent these pathways contribute to clinical/histologic heterogeneity and/or distinct disease endotypes remains unexplored.MethodsWe retrospectively analyzed 30 GA biopsies with either palisaded or interstitial histology with and without eosinophils. We performed RNA in situ hybridization to assess how markers of Type 1 (interferon gamma), Type 2 (interleukin [IL]4, IL13, IL5), and Type 3 (IL17A) immunity in GA compared with canonical inflammatory disorders and whether markers correlated with histology. We analyzed another cohort of 14 patients who had multiple biopsies across anatomic space and time for individual conservation of histologic features.ResultsInterferon (IFN)G staining is highest in GA relative to other cytokines. Type 2 cytokine staining is less prominent, with IL4 increased in interstitial pattern cases. Eosinophils did not correlate with Type 2 markers. Patients with multiple biopsies display intrapatient variability in histology.ConclusionType 1 inflammation predominates over Type 2 inflammation in GA irrespective of histologic pattern. Distinct disease endotypes were not detected.

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Recalcitrant generalized granuloma annulare treated successfully with dupilumab

Cited by 11 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

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

Retrospective assessment of immunologic and histologic heterogeneity in granuloma annulare by cytokine staining

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