Resolving Granuloma Annulare With Etanercept

Shupack, Jerome L.; Siu, Kimberly

doi:10.1001/archderm.142.3.394

Cited by 41 publications

(30 citation statements)

References 5 publications

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“…The patient was still clear 12 weeks after treatment. The mechanism of action of TNF-α inhibitors in GA is likely similar to that of other granulomatous diseases [47].…”

Section: -Granuloma Annularementioning

confidence: 81%

Off-Label Dermatological Uses of Etanercept Treatment

2016

J turk acad dermatol

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Background: Tumor necrosis factor-alpha (TNF-α) is a proinflammatory cytokine that plays an immunomodulatory role in a variety of systemic and dermatologic disease. Its blockade can be achieved by using specific inhibitors like etanercept. At present, etanercept is approved for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis and psoriasis treatment. However, it has been used with promising results in other inflammatory dermatoses. Etanercept treatment have been reported in the following dermatologic diseases: sarcoidosis, hidradenitis suppurativa, acne vulgaris, cicatricial pemphigoid, pemphigus vulgaris, Hailey-Hailey disease, Behçet' s disease, oral aphthous stomatitis, pyoderma gangrenosum, multicentric reticulohistiocytosis, apthous stomatitis, Sneddon-Wilkinson disease, acrodermatitis continua of Hallopeau, SAPHO syndrome, pityriasis rubra pilaris, vitiligo, necrobiosis lipoidica, silicone granulomas, Sweet's syndrome, atopic dermatitis, dyshidrotic eczema, toxic epidermal necrolysis, alopecia areata, centrifugal annular erythema, primary amyloidosis, erythroderma-related pruritus in Sézary syndrome, cutaneous T-cell lymphoma, inflammatory linear verrucous epidermal nevus, excessive scarring, postherpetic neuralgia, dermatomyositis, vasculitis, lupus erythematosus, and scleroderma. The vast majority of these reports are in the form of individual case reports and small case series. A growing number of published reports suggest that etanercept treatment may be effective in the treatment of numerous inflammatory skin disease outside their currently approved indications.

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“…The patient was still clear 12 weeks after treatment. The mechanism of action of TNF-α inhibitors in GA is likely similar to that of other granulomatous diseases [47].…”

Section: -Granuloma Annularementioning

confidence: 81%

Off-Label Dermatological Uses of Etanercept Treatment

2016

J turk acad dermatol

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“…In 2 patients treated with infliximab [26,27], in 1 patient treated with adalimumab [28] and in 1 patient treated with etanercept [29], DGA markedly improved within 6-10 weeks; however, in another patient etanercept failed to show any efficacy [30]. Interestingly, DGA was reported to occur as a side effect of TNF-α inhibitors in 9 of 199 patients treated for rheumatoid arthritis [31], and another patient with rheumatoid arthritis developed DGA under treatment first with infliximab and second with etanercept which in both cases quickly resolved after cessation of the TNF-α inhibitor.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Disseminated Granuloma Annulare with Oral Vitamin E: ‘Primum Nil Nocere'

et al. 2013

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Background: Disseminated granuloma annulare (DGA) is a benign and usually asymptomatic skin disease. However, many patients feel aesthetically disfigured and ask for treatment. Until today, no standard therapy is recommended. Objective: To evaluate the safety and efficacy of oral vitamin E treatment compared to the natural course of DGA. Methods: This single-centre observational cohort study included 38 consecutive patients with histologically confirmed DGA. 21 patients underwent treatment with oral vitamin E, whereas 17 patients preferred a wait-and-see approach. Results: Complete healing (40%) and improvement (30%) were frequently seen under oral vitamin E therapy. However, DGA also spontaneously disappeared in 31% and improved in 25% of untreated control patients. Vitamin E therapy was very well tolerated. Conclusions: Oral vitamin E treatment is a safe and probably effective therapy for DGA. As the natural course of DGA leads to complete healing or significant improvement in many cases, ‘primum nil nocere' should be the maxim.

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“…On the basis of the implication of the tumor necrosis factor α (TNF-α), a proinflammatory cytokine, on the formation of granulomas, the anti-TNF-α agents infliximab and etanercept have been successfully employed in the treatment of cutaneous granulomatous diseases such as silicone granulomas [15], granuloma annulare [16] and sarcoidosis [17]. Etanercept (a dimeric fusion protein) and infliximab (a humanized monoclonal antibody) both bind soluble and transmembrane-bound TNF-α and inhibit the TNF-α inflammatory cascade [15,16,17].…”

Section: Discussionmentioning

confidence: 99%

“…Etanercept (a dimeric fusion protein) and infliximab (a humanized monoclonal antibody) both bind soluble and transmembrane-bound TNF-α and inhibit the TNF-α inflammatory cascade [15,16,17]. The reported response of NL to pentoxifylline [18], a partial TNF-α inhibitor, indicated a possible role of this cytokine in this disease and prompted some authors to initiate anti-TNF-α therapy in treatment-resistant NL [19].…”

Section: Discussionmentioning

confidence: 99%

“…Another controversial point that needs to be elucidated is the fact that, although anti-TNF-α agents are effective for dermatological patients with chronic granulomatous skin diseases [16,17], paradoxically, the onset of the same diseases has been reported in rheumatological patients receiving anti-TNF-α therapy [27,28]. To the best of our knowledge, the onset of NL after starting anti-TNF-α therapy has not been reported so far.…”

Section: Discussionmentioning

confidence: 99%

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Necrobiosis Lipoidica Therapy with Biologicals: An Ulcerated Case Responding to Etanercept and a Review of the Literature

Suárez-Amor¹,

Pérez‐Bustillo²,

Ruíz‐González³

et al. 2010

Dermatology

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Necrobiosis lipoidica (NL) is an idiopathic chronic granulomatous skin condition. There is currently no standardized effective treatment of NL. Ulceration occurs in up to 35% of cases. Treatment of ulcerative lesions is challenging and often unsuccessful. On the basis of the implication of the tumor necrosis factor α (TNF-α) on the formation of granulomas, since 2003 anti-TNF-α agents have been employed in cases of NL refractory to other therapeutic agents. We report a 50-year-old white woman with treatment-resistant chronic ulcerative NL of both shins successfully treated with subcutaneous etanercept. A review of the published literature suggests that biological agents (etanercept and infliximab) should be considered as a therapeutic alternative mainly in ulcerative NL unresponsive to prior conventional regimens. The dose and duration of treatment with these agents is not defined, therefore it is required to report management of these patients in order to develop an optimal therapeutic strategy.

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Resolving Granuloma Annulare With Etanercept

Cited by 41 publications

References 5 publications

Off-Label Dermatological Uses of Etanercept Treatment

Off-Label Dermatological Uses of Etanercept Treatment

Treatment of Disseminated Granuloma Annulare with Oral Vitamin E: ‘Primum Nil Nocere'

Necrobiosis Lipoidica Therapy with Biologicals: An Ulcerated Case Responding to Etanercept and a Review of the Literature

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