Treatment of Granuloma Annulare With Pentoxifylline and Oral Vitamin E: A Case Series

Abstract

Granuloma annulare (GA) is a difficult-to-treat granulomatous skin disorder characterized by multiple annular, raised, and erythematous lesions. While numerous therapies have been proposed, there is currently no clear gold standard of treatment.We present a series of five patients with biopsy-proven generalized GA who were treated with pentoxifylline and oral vitamin E. Each patient in this series had at least a one-year history of GA refractory to other treatments. After three months of treatment, four of the five patients demonstrated objective improvement in their lesions through before and after clinical photographs. No patients suffered any adverse events on this treatment regimen.As our series has demonstrated modest benefits in concurrence with previously published studies, we recommend combination therapy with pentoxifylline and vitamin E as a strong contender for first-or second-line treatment for generalized GA. Pentoxifylline and vitamin E are advantageous for their tolerability, cost-effectiveness, minimal drug interactions, and convenience.

Treatment of refractory generalized granuloma annulare with oral vitamin E and topical tea tree oil

“…Some of these less commonly utilized treatments for GA include vitamin E and pentoxifylline. 2 Vitamin E, or tocopherol, has been used for treating GA since the 1940s. 3 Many patients view alternative treatments favorably, and this is particularly relevant in patients who have failed to respond to conventional therapies.…”

“…Topical formulations oxidize quickly when exposed to light and air. Additional considerations include interactions with vitamin K–dependent clotting factors in patients taking large doses of 1000 IU of oral vitamin E. 2 , 7 …”

Pentoxifylline in dermatology

“…Granuloma annulare (GA) is a cutaneous granulomatous inflammatory disease characterized by annulare erythematous papules and plaques 27 . Four case reports and one retrospective review were identified, totaling 37 patients treated with pentoxifylline for GA 27–31 .…”

“…Granuloma annulare (GA) is a cutaneous granulomatous inflammatory disease characterized by annulare erythematous papules and plaques. 27 Four case reports and one retrospective review were identified, totaling 37 patients treated with pentoxifylline for GA. [27][28][29][30][31] A retrospective review of 27 patients treated with pentoxifylline reported improvement in 56% and complete resolution occurred in 15% patients. 31 Five additional cases treated with pentoxifylline all had drastic improvement of lesions within 6 months.…”

Colchicine vs pentoxifylline vs minocycline for generalized granuloma annulare: A retrospective cohort study

“… 1 , 2 Although hydroxychloroquine, dapsone, methotrexate, and phototherapy have the most evidence in GGA, data regarding other systemic medications, such as colchicine, pentoxifylline, and minocycline, are generally limited to case reports and small case series (<10 patients). 2 , 3 , 4 , 5 We evaluated our experiences with colchicine, pentoxifylline, and minocycline in 42 patients with GGA.…”