Treatment of generalized granuloma annulare – a systematic review

Abstract

Granuloma annulare (GA) is a benign inflammatory skin disease. Localized GA is likely to resolve spontaneously, while generalized GA (GGA) is rare and may persist for decades. GGA usually is resistant to a variety of therapeutic modalities and takes a chronic course. The objective of this study was to summarize all reported treatments of generalized granuloma annulare. This is a systematic review based on MEDLINE, Embase and Cochrane Central Register search of articles in English and German and a manual search, between 1980 and 2013, to summarize the treatment of generalized granuloma annulare. Most medical literature on treatment of GGA is limited to individual case reports and small series of patients treated without a control group. Randomized controlled clinical studies are missing. Multiple treatment modalities for GGA were reported including topical and systemic steroids, PUVA, isotretinoin, dapsone, pentoxifylline, hydroxychloroquine, cyclosporine, IFN-γ, potassium iodide, nicotinamide, niacinamide, salicylic acid, dipyridamole, PDT, fumaric acid ester, etanercept, infliximab, adalimumab. While there are numerous case reports of successful treatments in the literature including surgical, medical and phototherapy options, well-designed, randomized, controlled clinical trials are required for an evidence-based treatment of GGA.

The role of biologics in the treatment of chronic granuloma annulare

“…In the localized form, lesions are primarily limited to the dorsal regions of the hands and feet and are more likely to resolve spontaneously. Disseminated GA (DGA), which is characterized as having greater than or equal to 10 GA lesions or widespread plaques, may persist for several years and is often refractory to treatment . IGD presents as violaceous, nonpruritic indurated linear cords or bands on the trunk or axillae and is often associated with arthritis .…”

“…Disseminated GA (DGA), which is characterized as having greater than or equal to 10 GA lesions or widespread plaques, may persist for several years and is often refractory to treatment. 2 IGD presents as violaceous, nonpruritic indurated linear cords or bands on the trunk or axillae and is often associated with arthritis. 3 AG is also characterized by erythematous, annular plaques but is found specifically on sun-exposed areas and is histologically distinct, lacking necrobiosis and mucin, and confined to the superficial dermis.…”

Generalized granuloma annulare coexisting with metastatic carcinoma of unknown origin (CUP syndrome) – a case report

“…Rozsiana postać ziarniniaka obrączkowatego jest rozważana jako paraneoplastyczna reakcja ziarniniakowa na chłoniaka Hodgkina, chłoniaki pierwotnie skórne (ziarniniakowa postać mycosis fungoides), ponadto na przewlekłą białaczkę szpikową, rzadziej na nowotwory lite. Dotychczas opisano przypadki współistnienia GGA z rakiem płuc, szyjki macicy, piersi, jajnika i prostaty [2,11,12]. W dostępnym piśmiennictwie nie znaleziono opisu przypadku współistnienia rozsianej postaci ziarniniaka obrączkowatego z CUP syndrome.…”

Reactive Granulomatous Dermatitis during Anti-TNF Therapy: A Case Report and Review of the Literature

“…Laboratory screening excluded occult infections by HCV, HBV, HIV and Treponema Pallidum; the QuantiFERON TB Gold assay and a chest X-ray were Probably, the first cases of PNGD were described in 1965 by Dykman, et al [14] as an "unusual form of rheuto unifying three dermatologic confounding entities: PNGD, IGD and IGDR [12]. ease have been successfully treated with TNFα blockers, including adalimumab [34][35][36][37].…”