Materiały źródłowe

• #1 Granuloma annulare // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/granuloma-annulare

  Granuloma annulare can clear on its own over time. Treatment might help clear the skin faster than if left untreated, but the condition often returns. The bumps that return after treatment tend to appear at the same spots, and 80% of those usually clear within two years. […] Treatment options include: […] Corticosteroid creams or ointments. Prescription-strength products may help clear the skin faster. Your health care provider may direct you to cover the cream with bandages or an adhesive patch, to help the medicine work better. […] Corticosteroid injections. If the skin isn’t clearing up with a medicated cream or ointment, your health care provider may suggest a corticosteroid injection. Repeat injections may be needed every 6 to 8 weeks until the condition clears up. […] Freezing. Applying liquid nitrogen to the affected area may help remove the bumps. […] Light therapy. Exposing the affected skin to certain types of light, including lasers, is sometimes helpful. […] Oral medicines. When the condition is widespread, your health care provider might prescribe medicine taken by mouth, such as antibiotics or antimalarials.

• #2 Granuloma annulare: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/granuloma-annulare-treatment

  Most people dont need treatment. This skin condition tends to clear on its own. Since its not contagious, you can leave it alone until it clears. Clearing may take a few months or a few years. Most people see their skin clear within two years. […] If you have a type of granuloma annulare that covers a large area of your body or causes a deep growth in your skin, your dermatologist may recommend treatment. Treatment may also be an option if you have noticeable patches and dislike how your skin looks. […] If you have a few noticeable patches, these are often treated with: Corticosteroids you apply to your skin: This medication reduces inflammation, which can help your skin clear more quickly. […] Injections of a corticosteroid: Your dermatologist may inject the patches to reduce the inflammation, which can help your skin clear more quickly.

• #3 Granuloma annulare // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/granuloma-annulare

  Granuloma annulare can clear on its own over time. Treatment might help clear the skin faster than if left untreated, but the condition often returns. The bumps that return after treatment tend to appear at the same spots, and 80% of those usually clear within two years. […] Treatment options include: […] Corticosteroid creams or ointments. Prescription-strength products may help clear the skin faster. Your health care provider may direct you to cover the cream with bandages or an adhesive patch, to help the medicine work better. […] Corticosteroid injections. If the skin isn’t clearing up with a medicated cream or ointment, your health care provider may suggest a corticosteroid injection. Repeat injections may be needed every 6 to 8 weeks until the condition clears up. […] Freezing. Applying liquid nitrogen to the affected area may help remove the bumps. […] Light therapy. Exposing the affected skin to certain types of light, including lasers, is sometimes helpful. […] Oral medicines. When the condition is widespread, your health care provider might prescribe medicine taken by mouth, such as antibiotics or antimalarials.

• #4 Diagnosis and Management of Granuloma Annulare | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1729.html

  Granuloma annulare is a benign skin condition that typically consists of grouped papules in an enlarging annular shape. […] Because localized granuloma annulare is self-limited, no treatment other than reassurance may be necessary. […] Treatment recommendations are based on the patho-physiology of the disease, expert opinion, and case reports only. Liquid nitrogen, injected steroids, or topical steroids under occlusion have been recommended for treatment of localized disease. […] Disseminated granuloma annulare may be treated with one of several systemic therapies such as dapsone, retinoids, niacinamide, antimalarials, psoralen plus ultraviolet A therapy, fumaric acid esters, tacrolimus, and pimecrolimus. […] Consultation with a dermatologist is recommended because of the possible toxicities of these agents.

• #5 Diagnosis and Management of Granuloma Annulare | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1729.html

  Localized granuloma annulare is self-limited and asymptomatic and usually does not require treatment. […] Options for treatment of localized granuloma annulare include liquid nitrogen, injected steroids, and topical steroids. […] Treatment for disseminated granuloma annulare should be undertaken in consultation with a dermatologist; options include dapsone, retinoids, antimalarial drugs, tacrolimus (Protopic), and pimecrolimus (Elidel). […] Medical literature contains limited reliable information on the treatment of granuloma annulare. […] Because localized granuloma annulare is self-limited and asymptomatic, treatment usually is not necessary. […] Nevertheless, many patients remain troubled by the appearance and persist in seeking treatment. For patients insisting on treatment, options include intralesional corticosteroid injection with 2.5 to 5.0 mg per mL triamcinolone (Aristocort) into the elevated border, topical corticosteroids under occlusion, cryotherapy, and electrodesiccation.

• #6 Granuloma annulare: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/granuloma-annulare-treatment

  Most people dont need treatment. This skin condition tends to clear on its own. Since its not contagious, you can leave it alone until it clears. Clearing may take a few months or a few years. Most people see their skin clear within two years. […] If you have a type of granuloma annulare that covers a large area of your body or causes a deep growth in your skin, your dermatologist may recommend treatment. Treatment may also be an option if you have noticeable patches and dislike how your skin looks. […] If you have a few noticeable patches, these are often treated with: Corticosteroids you apply to your skin: This medication reduces inflammation, which can help your skin clear more quickly. […] Injections of a corticosteroid: Your dermatologist may inject the patches to reduce the inflammation, which can help your skin clear more quickly.

• #7 Granuloma Annulare: Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/17874-granuloma-annulare

  Granuloma annulare is a long-lasting skin disorder that most commonly affects children and young adults. Treatments include medications and therapy. […] If granuloma annulare causes large areas of rash on your skin or deep, large lumps under your skin, your healthcare provider may recommend treatment. […] The purpose of treatment is to help control itching or pain. Treatments may speed up the time it takes for your rash to fade. […] Treatment options include: […] Certain medications can help clear your skin by reducing inflammation. Your healthcare provider may recommend corticosteroids, isotretinoin (Absorica, Zenatane) or tacrolimus (Protopic). […] This is a type of light therapy. Your healthcare provider combines a drug called psoralen with ultraviolet A light (PUVA). […] Your healthcare provider will freeze the affected areas of your skin using specialized equipment.

• #8 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Topical corticosteroids, with or without occlusion […] Intralesional corticosteroids […] Tacrolimus ointment or pimecrolimus cream […] Imiquimod cream […] Prednisone […] Isotretinoin […] Dapsone […] Antimalarials […] Cyclosporin […] Methotrexate […] Cryotherapy […] Photodynamic therapy […] Psoralen and ultraviolet A therapy (PUVA) […] Laser therapy (pulsed dye or CO2) […] Initial treatment for localized or limited disease is potent topical corticosteroids such as triamcinolone 0.1% ointment or clobetasol 0.05% ointment. These can be applied to individual lesions twice daily for several weeks. Intralesional corticosteroids can also be very effective at a 2.5mg/ml dosage, and may only require one treatment. […] Topical tacrolimus 0.1% ointment or pimecrolimus 1% cream for up to 12 weeks may also provide benefit, although the data consists of case reports, and patients must be made aware of the Food and Drug Administration (FDA) black box warnings for these products.

• #9 Granuloma annulare // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/granuloma-annulare

  Granuloma annulare can clear on its own over time. Treatment might help clear the skin faster than if left untreated, but the condition often returns. The bumps that return after treatment tend to appear at the same spots, and 80% of those usually clear within two years. […] Treatment options include: […] Corticosteroid creams or ointments. Prescription-strength products may help clear the skin faster. Your health care provider may direct you to cover the cream with bandages or an adhesive patch, to help the medicine work better. […] Corticosteroid injections. If the skin isn’t clearing up with a medicated cream or ointment, your health care provider may suggest a corticosteroid injection. Repeat injections may be needed every 6 to 8 weeks until the condition clears up. […] Freezing. Applying liquid nitrogen to the affected area may help remove the bumps. […] Light therapy. Exposing the affected skin to certain types of light, including lasers, is sometimes helpful. […] Oral medicines. When the condition is widespread, your health care provider might prescribe medicine taken by mouth, such as antibiotics or antimalarials.

• #10 Granuloma annulare // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/granuloma-annulare

  Granuloma annulare can clear on its own over time. Treatment might help clear the skin faster than if left untreated, but the condition often returns. The bumps that return after treatment tend to appear at the same spots, and 80% of those usually clear within two years. […] Treatment options include: […] Corticosteroid creams or ointments. Prescription-strength products may help clear the skin faster. Your health care provider may direct you to cover the cream with bandages or an adhesive patch, to help the medicine work better. […] Corticosteroid injections. If the skin isn’t clearing up with a medicated cream or ointment, your health care provider may suggest a corticosteroid injection. Repeat injections may be needed every 6 to 8 weeks until the condition clears up. […] Freezing. Applying liquid nitrogen to the affected area may help remove the bumps. […] Light therapy. Exposing the affected skin to certain types of light, including lasers, is sometimes helpful. […] Oral medicines. When the condition is widespread, your health care provider might prescribe medicine taken by mouth, such as antibiotics or antimalarials.

• #11 Diagnosis and Management of Granuloma Annulare | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1729.html

  Localized granuloma annulare is self-limited and asymptomatic and usually does not require treatment. […] Options for treatment of localized granuloma annulare include liquid nitrogen, injected steroids, and topical steroids. […] Treatment for disseminated granuloma annulare should be undertaken in consultation with a dermatologist; options include dapsone, retinoids, antimalarial drugs, tacrolimus (Protopic), and pimecrolimus (Elidel). […] Medical literature contains limited reliable information on the treatment of granuloma annulare. […] Because localized granuloma annulare is self-limited and asymptomatic, treatment usually is not necessary. […] Nevertheless, many patients remain troubled by the appearance and persist in seeking treatment. For patients insisting on treatment, options include intralesional corticosteroid injection with 2.5 to 5.0 mg per mL triamcinolone (Aristocort) into the elevated border, topical corticosteroids under occlusion, cryotherapy, and electrodesiccation.

• #12 Granuloma annulare // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/granuloma-annulare

  Granuloma annulare can clear on its own over time. Treatment might help clear the skin faster than if left untreated, but the condition often returns. The bumps that return after treatment tend to appear at the same spots, and 80% of those usually clear within two years. […] Treatment options include: […] Corticosteroid creams or ointments. Prescription-strength products may help clear the skin faster. Your health care provider may direct you to cover the cream with bandages or an adhesive patch, to help the medicine work better. […] Corticosteroid injections. If the skin isn’t clearing up with a medicated cream or ointment, your health care provider may suggest a corticosteroid injection. Repeat injections may be needed every 6 to 8 weeks until the condition clears up. […] Freezing. Applying liquid nitrogen to the affected area may help remove the bumps. […] Light therapy. Exposing the affected skin to certain types of light, including lasers, is sometimes helpful. […] Oral medicines. When the condition is widespread, your health care provider might prescribe medicine taken by mouth, such as antibiotics or antimalarials.

• #13 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Topical corticosteroids, with or without occlusion […] Intralesional corticosteroids […] Tacrolimus ointment or pimecrolimus cream […] Imiquimod cream […] Prednisone […] Isotretinoin […] Dapsone […] Antimalarials […] Cyclosporin […] Methotrexate […] Cryotherapy […] Photodynamic therapy […] Psoralen and ultraviolet A therapy (PUVA) […] Laser therapy (pulsed dye or CO2) […] Initial treatment for localized or limited disease is potent topical corticosteroids such as triamcinolone 0.1% ointment or clobetasol 0.05% ointment. These can be applied to individual lesions twice daily for several weeks. Intralesional corticosteroids can also be very effective at a 2.5mg/ml dosage, and may only require one treatment. […] Topical tacrolimus 0.1% ointment or pimecrolimus 1% cream for up to 12 weeks may also provide benefit, although the data consists of case reports, and patients must be made aware of the Food and Drug Administration (FDA) black box warnings for these products.

• #14

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Owing to the fact that GA encompasses a spectrum of disease of varying severity, it becomes essential to determine whether a diagnosis should consistently prompt treatment. […] Nevertheless, concern regarding the undetermined time to remission or psychological discomfort associated with the formation of lesions frequently causes a desire to proceed with therapy. […] Although high potency corticosteroids and intralesional corticosteroids appear to be the first step therapeutic approach, particularly in individuals with localized GA, there is no agreement on the optimal dosage and duration of treatment. […] The efficacy of topical corticosteroids is mostly limited to clinical experience with few case studies concerning usage of halobetasole, clobetasol propionate, mometasone furoate. […] Topical tacrolimus and pimecrolimus are frequently regarded as a safe option due to low number of side-effects. […] The reported therapies comprise topical application of 1% pimecrolimus or 0.1% tacrolimus ointments twice a day to the lesion site.

• #15 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Topical corticosteroids, with or without occlusion […] Intralesional corticosteroids […] Tacrolimus ointment or pimecrolimus cream […] Imiquimod cream […] Prednisone […] Isotretinoin […] Dapsone […] Antimalarials […] Cyclosporin […] Methotrexate […] Cryotherapy […] Photodynamic therapy […] Psoralen and ultraviolet A therapy (PUVA) […] Laser therapy (pulsed dye or CO2) […] Initial treatment for localized or limited disease is potent topical corticosteroids such as triamcinolone 0.1% ointment or clobetasol 0.05% ointment. These can be applied to individual lesions twice daily for several weeks. Intralesional corticosteroids can also be very effective at a 2.5mg/ml dosage, and may only require one treatment. […] Topical tacrolimus 0.1% ointment or pimecrolimus 1% cream for up to 12 weeks may also provide benefit, although the data consists of case reports, and patients must be made aware of the Food and Drug Administration (FDA) black box warnings for these products.

• #16 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Topical corticosteroids, with or without occlusion […] Intralesional corticosteroids […] Tacrolimus ointment or pimecrolimus cream […] Imiquimod cream […] Prednisone […] Isotretinoin […] Dapsone […] Antimalarials […] Cyclosporin […] Methotrexate […] Cryotherapy […] Photodynamic therapy […] Psoralen and ultraviolet A therapy (PUVA) […] Laser therapy (pulsed dye or CO2) […] Initial treatment for localized or limited disease is potent topical corticosteroids such as triamcinolone 0.1% ointment or clobetasol 0.05% ointment. These can be applied to individual lesions twice daily for several weeks. Intralesional corticosteroids can also be very effective at a 2.5mg/ml dosage, and may only require one treatment. […] Topical tacrolimus 0.1% ointment or pimecrolimus 1% cream for up to 12 weeks may also provide benefit, although the data consists of case reports, and patients must be made aware of the Food and Drug Administration (FDA) black box warnings for these products.

• #17 Granuloma Annulare: Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/17874-granuloma-annulare

  Granuloma annulare is a long-lasting skin disorder that most commonly affects children and young adults. Treatments include medications and therapy. […] If granuloma annulare causes large areas of rash on your skin or deep, large lumps under your skin, your healthcare provider may recommend treatment. […] The purpose of treatment is to help control itching or pain. Treatments may speed up the time it takes for your rash to fade. […] Treatment options include: […] Certain medications can help clear your skin by reducing inflammation. Your healthcare provider may recommend corticosteroids, isotretinoin (Absorica, Zenatane) or tacrolimus (Protopic). […] This is a type of light therapy. Your healthcare provider combines a drug called psoralen with ultraviolet A light (PUVA). […] Your healthcare provider will freeze the affected areas of your skin using specialized equipment.

• #18 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Cryotherapy has been shown to lead to an 81% resolution rate for localized disease. […] Generalized GA may require systemic therapy, although application of topical steroids to lesions affecting a broad area may still be possible. […] Prednisone can be effective, but the need for prolonged treatment, with the associated side effects, may outweigh the utility. […] Similarly, oral retinoids such as isotretinoin at 40mg daily for 8-12 weeks may lead to a 90% response rate, but is associated with liver and lipid abnormalities. […] Photodynamic therapy with 5-aminolevulinic acid or PUVA can be effective, but may not be practical due to the need for frequent treatments. […] There have been multiple reports of other modalities being used, with varying success; however, they consist of small case studies or retrospective reviews with small numbers of patients. Examples of such medications include dapsone and hydroxychloroquine. […] All treatments for GA have potential side effects, and therefore the risk must be balanced against the benefit. Since this is generally an asymptomatic self-limited disease, reassurance may be the best option. In general, topical modalities can be effective and should be thought of as first line.

• #19

  https://111.wales.nhs.uk/granulomaannulare/

  Granuloma annulare is harmless and sometimes disappears without treatment. But it can take a long time to clear up (2 to 10 years) and it often comes back. […] A skin specialist (dermatologist) may suggest treatment if granuloma annulare affects a visible or large area of your body and its affecting your life. […] Treatments for granuloma annulare can include: steroid medicines which may be creams, tablets or injections, freezing small areas of skin (cryotherapy) this can leave a permanent scar, ultraviolet light therapy light is used to reduce the inflammation in the skin, skin camouflage (make-up). […] There are different types of granuloma annulare and some can be difficult to treat. Your doctor will talk to you about your options.

• #20 Granuloma Annulare Condition, Treatments and Pictures for Adults – Skinsight

  https://skinsight.com/skin-conditions/granuloma-annulare/

  If the diagnosis of granuloma annulare is not obvious, a dermatologist may want to perform a skin biopsy. […] Once the diagnosis of granuloma annulare is confirmed, you and your medical professional may decide not to treat it, as many cases of granuloma annulare clear up within 2 years, even without treatment. […] If the lesions of granuloma annulare cause discomfort or are widespread or cosmetically bothersome, your medical professional may try one of the following: a prescription-strength steroid cream, steroid injections directly into the lesions or freezing with liquid nitrogen (cryotherapy). In darker skin colors, these treatments may leave an area of lighter skin color. […] Generalized granuloma annulare is more stubborn, with fewer cases of spontaneous resolution and more recurrences. In addition, other treatments may be used: oral steroids, such as prednisone (Rayos), ultraviolet light, other oral medications such as dapsone, hydroxychloroquine (Plaquenil), or isotretinoin (Amnesteem, Claravis).

• #21

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  While further research regarding the role of topical vitamin E is needed its efficacy may stem from its antioxidative potential and the ability to neutralize free oxygen radicals. […] Topical application of vitamin E has shown promising results in localized GA, leading to complete healing of lesions within 13 weeks without recurrence in one-year follow-up. […] In a retrospective study involving 33 patients, phototherapy with additional psoralen (PUVA) resulted in 50% clearance rate after 22 sessions. […] In another retrospective analysis, 13 patients were treated with narrowband UVB phototherapy (NB-UVB), with 54% of them responding to the treatment, including 23% with complete response and 31% with partial response. […] Numerous studies support the effectiveness of lasers, including Pulsed Dye Laser (PDL), excimer laser and Fractional Photothermolysis (FP) in the treatment of GA, especially localized type. […] Among the benefits of laser treatment are: avoidance of the negative effects of steroids, low systemic toxicity, and low levels of associated morbidity.

• #22 Granuloma Annulare: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1123031-overview

  Treatment of generalized granuloma annulare with dapsone. […] Successful treatment of generalized granuloma annulare with adalimumab. […] Treatment of recalcitrant generalized granuloma annulare with adalimumab. […] Treatment of disseminated granuloma annulare with pulse therapy upadacitinib. […] Ruxolitinib cream for the treatment of granuloma annulare. […] Treatment of Granuloma Annulare Using Tapinarof Cream 1.

• #23 Granuloma Annulare – Array Skin Therapy

  https://arrayskin.com/granuloma-annulare/

  Granuloma annulare treatment can include medicated creams, steroid injections, oral medications, and/or narrowband UVB phototherapy, also known as light therapy. […] Array Skin Therapy offers narrowband UVB light therapy to help lessen or alleviate bothersome skin symptoms associated with granuloma annulare. Light therapy treatment for granuloma annulare can reduce inflammation, resulting in a more even skin tone. […] Light therapy treatment for granuloma annulare is required two or three times each week and may be necessary to continue for several months, depending on the individuals desired result. Patients usually notice some improvement in their symptoms by 10-15 treatments, with more significant improvement noted around 30 treatments. When patients are satisfied with their level of improvement, we encourage them to take a break from light therapy and monitor their skin closely. If you are interested in light therapy for the treatment of granuloma annulare, call us to schedule a consultation with one of our nurse practitioners.

• #24 Granuloma Annulare – Array Skin Therapy

  https://arrayskin.com/granuloma-annulare/

  Granuloma annulare treatment can include medicated creams, steroid injections, oral medications, and/or narrowband UVB phototherapy, also known as light therapy. […] Array Skin Therapy offers narrowband UVB light therapy to help lessen or alleviate bothersome skin symptoms associated with granuloma annulare. Light therapy treatment for granuloma annulare can reduce inflammation, resulting in a more even skin tone. […] Light therapy treatment for granuloma annulare is required two or three times each week and may be necessary to continue for several months, depending on the individuals desired result. Patients usually notice some improvement in their symptoms by 10-15 treatments, with more significant improvement noted around 30 treatments. When patients are satisfied with their level of improvement, we encourage them to take a break from light therapy and monitor their skin closely. If you are interested in light therapy for the treatment of granuloma annulare, call us to schedule a consultation with one of our nurse practitioners.

• #25

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  While further research regarding the role of topical vitamin E is needed its efficacy may stem from its antioxidative potential and the ability to neutralize free oxygen radicals. […] Topical application of vitamin E has shown promising results in localized GA, leading to complete healing of lesions within 13 weeks without recurrence in one-year follow-up. […] In a retrospective study involving 33 patients, phototherapy with additional psoralen (PUVA) resulted in 50% clearance rate after 22 sessions. […] In another retrospective analysis, 13 patients were treated with narrowband UVB phototherapy (NB-UVB), with 54% of them responding to the treatment, including 23% with complete response and 31% with partial response. […] Numerous studies support the effectiveness of lasers, including Pulsed Dye Laser (PDL), excimer laser and Fractional Photothermolysis (FP) in the treatment of GA, especially localized type. […] Among the benefits of laser treatment are: avoidance of the negative effects of steroids, low systemic toxicity, and low levels of associated morbidity.

• #26 Successful Treatment of Disseminated Granuloma Annulare With Narrowband UV-B Phototherapy | Actas Dermo-Sifiliográficas

  https://actasdermo.org/en-successful-treatment-disseminated-granuloma-annulare-articulo-S157821901500027X

  NB-UVB phototherapy, with an emission spectrum of 311-313nm, has been used for many years to treat psoriasis, and poses a lower risk of erythema and carcinogenicity than broadband UVB. […] Several variables should be considered when selecting systemic treatment for DGA, including the patients baseline blood evaluations, comorbidities, interactions with other drugs, potential adverse effects, and prior treatments.

• #27 Successful Treatment of Disseminated Granuloma Annulare With Narrowband UV-B Phototherapy | Actas Dermo-Sifiliográficas

  https://actasdermo.org/en-successful-treatment-disseminated-granuloma-annulare-articulo-S157821901500027X

  Disseminated granuloma annulare (DGA) is an inflammatory disease that tends to follow a chronic course and is resistant to multiple treatments. […] The patient was prescribed several cycles of oral prednisone (30mg per day in decreasing doses for periods of 6 weeks) and topical corticosteroids (15 days) with no improvement. […] The patient underwent narrowband ultraviolet-B (NB-UVB) phototherapy 3 times per week for 2.5 months, following a dose escalation protocol for skin phototype II. […] This is the second reported case of DGA treated with NB-UVB. […] A lack of evidence-based treatment guidelines makes DGA treatment challenging for the dermatologist. […] Among the most commonly used treatments are topical, oral, intralesional, and intramuscular corticosteroids, biological agents, surgery, laser treatment, and phototherapy.

• #28 Granuloma Annulare: Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/17874-granuloma-annulare

  Granuloma annulare is a long-lasting skin disorder that most commonly affects children and young adults. Treatments include medications and therapy. […] If granuloma annulare causes large areas of rash on your skin or deep, large lumps under your skin, your healthcare provider may recommend treatment. […] The purpose of treatment is to help control itching or pain. Treatments may speed up the time it takes for your rash to fade. […] Treatment options include: […] Certain medications can help clear your skin by reducing inflammation. Your healthcare provider may recommend corticosteroids, isotretinoin (Absorica, Zenatane) or tacrolimus (Protopic). […] This is a type of light therapy. Your healthcare provider combines a drug called psoralen with ultraviolet A light (PUVA). […] Your healthcare provider will freeze the affected areas of your skin using specialized equipment.

• #29 Granuloma Annulare Treatment In Boardman, OH

  https://www.advancedderm.net/granuloma/

  Granuloma annulare treatment is to help control the symptoms of this condition, such as itching or pain. […] The specific treatment you will receive will be determined by your physician during your appointment. Medications, such as corticosteroids, isotretinoin, or tacrolimus, may help clear your skin by reducing inflammation in your body. Other medications, such as those used to treat malaria, can help reduce the appearance of the rash or lesions on your skin. […] PUVA therapy, sometimes called photochemotherapy, is a form of light therapy that uses psoralen, a drug either taken orally or given as a soak, followed by exposure of the affected skin to UVA light. […] Cryotherapy uses special equipment to freeze the area of the skin affected by granuloma annulare in an attempt to halt the growth of skin lesions or patches.

• #30

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  While further research regarding the role of topical vitamin E is needed its efficacy may stem from its antioxidative potential and the ability to neutralize free oxygen radicals. […] Topical application of vitamin E has shown promising results in localized GA, leading to complete healing of lesions within 13 weeks without recurrence in one-year follow-up. […] In a retrospective study involving 33 patients, phototherapy with additional psoralen (PUVA) resulted in 50% clearance rate after 22 sessions. […] In another retrospective analysis, 13 patients were treated with narrowband UVB phototherapy (NB-UVB), with 54% of them responding to the treatment, including 23% with complete response and 31% with partial response. […] Numerous studies support the effectiveness of lasers, including Pulsed Dye Laser (PDL), excimer laser and Fractional Photothermolysis (FP) in the treatment of GA, especially localized type. […] Among the benefits of laser treatment are: avoidance of the negative effects of steroids, low systemic toxicity, and low levels of associated morbidity.

• #31 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Cryotherapy has been shown to lead to an 81% resolution rate for localized disease. […] Generalized GA may require systemic therapy, although application of topical steroids to lesions affecting a broad area may still be possible. […] Prednisone can be effective, but the need for prolonged treatment, with the associated side effects, may outweigh the utility. […] Similarly, oral retinoids such as isotretinoin at 40mg daily for 8-12 weeks may lead to a 90% response rate, but is associated with liver and lipid abnormalities. […] Photodynamic therapy with 5-aminolevulinic acid or PUVA can be effective, but may not be practical due to the need for frequent treatments. […] There have been multiple reports of other modalities being used, with varying success; however, they consist of small case studies or retrospective reviews with small numbers of patients. Examples of such medications include dapsone and hydroxychloroquine. […] All treatments for GA have potential side effects, and therefore the risk must be balanced against the benefit. Since this is generally an asymptomatic self-limited disease, reassurance may be the best option. In general, topical modalities can be effective and should be thought of as first line.

• #32

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  While further research regarding the role of topical vitamin E is needed its efficacy may stem from its antioxidative potential and the ability to neutralize free oxygen radicals. […] Topical application of vitamin E has shown promising results in localized GA, leading to complete healing of lesions within 13 weeks without recurrence in one-year follow-up. […] In a retrospective study involving 33 patients, phototherapy with additional psoralen (PUVA) resulted in 50% clearance rate after 22 sessions. […] In another retrospective analysis, 13 patients were treated with narrowband UVB phototherapy (NB-UVB), with 54% of them responding to the treatment, including 23% with complete response and 31% with partial response. […] Numerous studies support the effectiveness of lasers, including Pulsed Dye Laser (PDL), excimer laser and Fractional Photothermolysis (FP) in the treatment of GA, especially localized type. […] Among the benefits of laser treatment are: avoidance of the negative effects of steroids, low systemic toxicity, and low levels of associated morbidity.

• #33

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  While further research regarding the role of topical vitamin E is needed its efficacy may stem from its antioxidative potential and the ability to neutralize free oxygen radicals. […] Topical application of vitamin E has shown promising results in localized GA, leading to complete healing of lesions within 13 weeks without recurrence in one-year follow-up. […] In a retrospective study involving 33 patients, phototherapy with additional psoralen (PUVA) resulted in 50% clearance rate after 22 sessions. […] In another retrospective analysis, 13 patients were treated with narrowband UVB phototherapy (NB-UVB), with 54% of them responding to the treatment, including 23% with complete response and 31% with partial response. […] Numerous studies support the effectiveness of lasers, including Pulsed Dye Laser (PDL), excimer laser and Fractional Photothermolysis (FP) in the treatment of GA, especially localized type. […] Among the benefits of laser treatment are: avoidance of the negative effects of steroids, low systemic toxicity, and low levels of associated morbidity.

• #34

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  While further research regarding the role of topical vitamin E is needed its efficacy may stem from its antioxidative potential and the ability to neutralize free oxygen radicals. […] Topical application of vitamin E has shown promising results in localized GA, leading to complete healing of lesions within 13 weeks without recurrence in one-year follow-up. […] In a retrospective study involving 33 patients, phototherapy with additional psoralen (PUVA) resulted in 50% clearance rate after 22 sessions. […] In another retrospective analysis, 13 patients were treated with narrowband UVB phototherapy (NB-UVB), with 54% of them responding to the treatment, including 23% with complete response and 31% with partial response. […] Numerous studies support the effectiveness of lasers, including Pulsed Dye Laser (PDL), excimer laser and Fractional Photothermolysis (FP) in the treatment of GA, especially localized type. […] Among the benefits of laser treatment are: avoidance of the negative effects of steroids, low systemic toxicity, and low levels of associated morbidity.

• #35

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Oral isotretinoin is best recognized for treating severe acne, although it has been demonstrated in multiple case studies to be successful in treating granuloma annulare. […] A systematic review enrolled 12 case reports or series with 16 patients who received 0.51 mg/kg/day oral isotretinoin, concluded that it effectively cleared lesions by at least 90% in all patients, regardless of GA variant type. […] The immunomodulatory characteristics of Fumaric Acid Esters (FAE) render them a feasible choice for managing GA, similar to their incorporation into conventional therapeutic regimens for psoriasis. […] Elevation and color of skin lesions significantly improved clinically as a result of systemic FAE therapy along with remission or partial remission in the majority of cases. […] Dapsone suppresses non-specific inflammatory effects and has been reported as a successful treatment of GA. […] More recent retrospective case series involving 26 GA patients treated with dapsone at a median dose of 100 mg per day for mean duration of 9.8 months observed regression of lesions in 14 of 26 (54%) patients.

• #36 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Cryotherapy has been shown to lead to an 81% resolution rate for localized disease. […] Generalized GA may require systemic therapy, although application of topical steroids to lesions affecting a broad area may still be possible. […] Prednisone can be effective, but the need for prolonged treatment, with the associated side effects, may outweigh the utility. […] Similarly, oral retinoids such as isotretinoin at 40mg daily for 8-12 weeks may lead to a 90% response rate, but is associated with liver and lipid abnormalities. […] Photodynamic therapy with 5-aminolevulinic acid or PUVA can be effective, but may not be practical due to the need for frequent treatments. […] There have been multiple reports of other modalities being used, with varying success; however, they consist of small case studies or retrospective reviews with small numbers of patients. Examples of such medications include dapsone and hydroxychloroquine. […] All treatments for GA have potential side effects, and therefore the risk must be balanced against the benefit. Since this is generally an asymptomatic self-limited disease, reassurance may be the best option. In general, topical modalities can be effective and should be thought of as first line.

• #37 Granuloma annulare: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/granuloma-annulare-treatment

  Cryosurgery: This freezes your skin, which can destroy the raised patches. […] If the granuloma annulare covers much of your skin or you have a deep lump in your skin, youll have different treatment options. For these types of granuloma annulare, you may need: Medication used to treat malaria: Studies have shown that this can be quite effective. It can take time to see the results. In one study, patients started to see results after taking the medication for about 3 months. […] Light therapy: Exposing the skin with granuloma annulare to ultraviolet (UV) light in a controlled way can be helpful. Some people receive a type of light therapy called PUVA. This involves taking a medication called psoralen and then treating the skin with UVA light. The medication makes your skin more sensitive to light, so light therapy can be more effective. Another type of light therapy, laser treatments, can also be helpful.

• #38 Granuloma annulare: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/granuloma-annulare-treatment

  Cryosurgery: This freezes your skin, which can destroy the raised patches. […] If the granuloma annulare covers much of your skin or you have a deep lump in your skin, youll have different treatment options. For these types of granuloma annulare, you may need: Medication used to treat malaria: Studies have shown that this can be quite effective. It can take time to see the results. In one study, patients started to see results after taking the medication for about 3 months. […] Light therapy: Exposing the skin with granuloma annulare to ultraviolet (UV) light in a controlled way can be helpful. Some people receive a type of light therapy called PUVA. This involves taking a medication called psoralen and then treating the skin with UVA light. The medication makes your skin more sensitive to light, so light therapy can be more effective. Another type of light therapy, laser treatments, can also be helpful.

• #39 Granuloma Annulare – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459377/

  Although the lesions of granuloma annulare usually regress, they tend to recur. For this reason, and for cosmetic reasons, treatment sometimes is indicated. Physicians try many therapies, but there is little research-based evidence to support them. […] Despite the lack of evidence, experts agree that intralesional steroid injection is first-line therapy for lesions of granuloma annulare. There are reports of improvement after certain types of trauma to the lesions such as biopsy, pricking, incision, and cryotherapy. Phototherapy has shown promising results in some studies. There are reports of success with both excimer laser and pulsed dye laser. Hydroxychloroquine has shown success in a few small studies and reports. Although more evidence is needed to prove efficacy, some researchers believe that hydroxychloroquine should be first-line therapy for generalized granuloma annulare. Tumor necrosis factor-alpha inhibitors have shown efficacy in treating generalized and recalcitrant granuloma annulare. However, as mentioned above, there are reports of TNF-alpha inhibitors triggering or exacerbating the disease, so more research is needed to weigh the risks and the benefits of using TNF-alpha inhibitors to treat this disease. Physicians have also tried surgical excision, but lesions tend to recur. […] In addition to the therapy mentioned above, vitamin E, isotretinoin, tetracyclines, intralesional interferons, topical imiquimod, niacinamide, oral calcitriol, dapsone, hydroxyurea, topical tacrolimus, clofazimine, and rifampin have been tried and reported to be effective in small studies.

• #40

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Oral isotretinoin is best recognized for treating severe acne, although it has been demonstrated in multiple case studies to be successful in treating granuloma annulare. […] A systematic review enrolled 12 case reports or series with 16 patients who received 0.51 mg/kg/day oral isotretinoin, concluded that it effectively cleared lesions by at least 90% in all patients, regardless of GA variant type. […] The immunomodulatory characteristics of Fumaric Acid Esters (FAE) render them a feasible choice for managing GA, similar to their incorporation into conventional therapeutic regimens for psoriasis. […] Elevation and color of skin lesions significantly improved clinically as a result of systemic FAE therapy along with remission or partial remission in the majority of cases. […] Dapsone suppresses non-specific inflammatory effects and has been reported as a successful treatment of GA. […] More recent retrospective case series involving 26 GA patients treated with dapsone at a median dose of 100 mg per day for mean duration of 9.8 months observed regression of lesions in 14 of 26 (54%) patients.

• #41

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Oral isotretinoin is best recognized for treating severe acne, although it has been demonstrated in multiple case studies to be successful in treating granuloma annulare. […] A systematic review enrolled 12 case reports or series with 16 patients who received 0.51 mg/kg/day oral isotretinoin, concluded that it effectively cleared lesions by at least 90% in all patients, regardless of GA variant type. […] The immunomodulatory characteristics of Fumaric Acid Esters (FAE) render them a feasible choice for managing GA, similar to their incorporation into conventional therapeutic regimens for psoriasis. […] Elevation and color of skin lesions significantly improved clinically as a result of systemic FAE therapy along with remission or partial remission in the majority of cases. […] Dapsone suppresses non-specific inflammatory effects and has been reported as a successful treatment of GA. […] More recent retrospective case series involving 26 GA patients treated with dapsone at a median dose of 100 mg per day for mean duration of 9.8 months observed regression of lesions in 14 of 26 (54%) patients.

• #42

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Oral isotretinoin is best recognized for treating severe acne, although it has been demonstrated in multiple case studies to be successful in treating granuloma annulare. […] A systematic review enrolled 12 case reports or series with 16 patients who received 0.51 mg/kg/day oral isotretinoin, concluded that it effectively cleared lesions by at least 90% in all patients, regardless of GA variant type. […] The immunomodulatory characteristics of Fumaric Acid Esters (FAE) render them a feasible choice for managing GA, similar to their incorporation into conventional therapeutic regimens for psoriasis. […] Elevation and color of skin lesions significantly improved clinically as a result of systemic FAE therapy along with remission or partial remission in the majority of cases. […] Dapsone suppresses non-specific inflammatory effects and has been reported as a successful treatment of GA. […] More recent retrospective case series involving 26 GA patients treated with dapsone at a median dose of 100 mg per day for mean duration of 9.8 months observed regression of lesions in 14 of 26 (54%) patients.

• #43

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Oral isotretinoin is best recognized for treating severe acne, although it has been demonstrated in multiple case studies to be successful in treating granuloma annulare. […] A systematic review enrolled 12 case reports or series with 16 patients who received 0.51 mg/kg/day oral isotretinoin, concluded that it effectively cleared lesions by at least 90% in all patients, regardless of GA variant type. […] The immunomodulatory characteristics of Fumaric Acid Esters (FAE) render them a feasible choice for managing GA, similar to their incorporation into conventional therapeutic regimens for psoriasis. […] Elevation and color of skin lesions significantly improved clinically as a result of systemic FAE therapy along with remission or partial remission in the majority of cases. […] Dapsone suppresses non-specific inflammatory effects and has been reported as a successful treatment of GA. […] More recent retrospective case series involving 26 GA patients treated with dapsone at a median dose of 100 mg per day for mean duration of 9.8 months observed regression of lesions in 14 of 26 (54%) patients.

• #44 Treatment of Disseminated Granuloma Annulare with Low-dose Fumaric Acid | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-0647

  In this clinical report, we have retrospectively analysed the therapeutic efficacy of low-dose FAE in 8 patients with disseminated GA. […] Using this treatment regimen, FAE are generally well-tolerated drugs suitable for long-term treatment in psoriasis. […] Thus, 6/8 patients improved, a success rate obtained with the most promising alternative treatments, such as bath PUVA therapy. […] In this report we are able to present data demonstrating a similar efficacy for low-dose therapy of disseminated GA compared with conventional dosage. It is tempting to speculate that the benefit-risk ratio of this low-dose regime appears to be increased due to the better tolerability of lower FAE dosages. […] Larger controlled prospective studies are needed to investigate the ideal treatment regimen and the effectiveness of FAE in patients with disseminated GA.

• #45 Treatment of Disseminated Granuloma Annulare with Low-dose Fumaric Acid | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-0647

  In this clinical report, we have retrospectively analysed the therapeutic efficacy of low-dose FAE in 8 patients with disseminated GA. […] Using this treatment regimen, FAE are generally well-tolerated drugs suitable for long-term treatment in psoriasis. […] Thus, 6/8 patients improved, a success rate obtained with the most promising alternative treatments, such as bath PUVA therapy. […] In this report we are able to present data demonstrating a similar efficacy for low-dose therapy of disseminated GA compared with conventional dosage. It is tempting to speculate that the benefit-risk ratio of this low-dose regime appears to be increased due to the better tolerability of lower FAE dosages. […] Larger controlled prospective studies are needed to investigate the ideal treatment regimen and the effectiveness of FAE in patients with disseminated GA.

• #46

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Given the function of Janus kinase (JAK) as a signal transducer and activator of transcription pathway in the development of GA, JAK inhibitors appear to be a promising treatment. […] Over a period of 4 to 8 months, all patients received 5 mg of tofacitinib twice daily. […] The use of JAK inhibitors seems to be a logical course of treatment, given the significance of Janus kinase in the pathophysiology of GA. […] Tofacitinib, upadacitinib, or baricitinib administration significantly improves lesions while displaying nearly no side effects.

• #47

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Given the function of Janus kinase (JAK) as a signal transducer and activator of transcription pathway in the development of GA, JAK inhibitors appear to be a promising treatment. […] Over a period of 4 to 8 months, all patients received 5 mg of tofacitinib twice daily. […] The use of JAK inhibitors seems to be a logical course of treatment, given the significance of Janus kinase in the pathophysiology of GA. […] Tofacitinib, upadacitinib, or baricitinib administration significantly improves lesions while displaying nearly no side effects.

• #48

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Given the function of Janus kinase (JAK) as a signal transducer and activator of transcription pathway in the development of GA, JAK inhibitors appear to be a promising treatment. […] Over a period of 4 to 8 months, all patients received 5 mg of tofacitinib twice daily. […] The use of JAK inhibitors seems to be a logical course of treatment, given the significance of Janus kinase in the pathophysiology of GA. […] Tofacitinib, upadacitinib, or baricitinib administration significantly improves lesions while displaying nearly no side effects.

• #49

  https://link.springer.com/article/10.1007/s13555-024-01117-z

  Disseminated granuloma annulare (DGA) is an inflammatory skin disorder characterized by more than 10 erythematous, raised, ring-shaped plaques. Its treatment remains challenging, with conventional therapies showing variable efficacy. […] Treatment with upadacitinib 30 mg per day was started with rapid effectiveness and good tolerance. This case underscores the potential of JAK inhibitors as promising therapeutic options for recalcitrant granuloma annulare. […] Treatment can be difficult and challenging, particularly in diffuse and generalized forms. Various conventional treatments (systemic corticosteroids, phototherapy, antimalarials, dapsone, etc.) have been proposed on the basis of case reports or clinical experience, with variable effectiveness. […] Given the recalcitrant and extensive nature of the lesions, and the recent evidence of the role of the Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway in the GA pathophysiology, treatment with upadacitinib 30 mg per day was started.

• #50

  https://link.springer.com/article/10.1007/s13555-024-01117-z

  At follow-up visit 2 months later, lesions had almost all disappeared and complete remission was achieved after 6 months. Upadacitinib was well tolerated; an increase of total cholesterol was controlled with atorvastatin 20 mg daily. […] This observation, in line with other rare cases reported in the literature, is very encouraging for the rapid effectiveness and good tolerance of JAK inhibitors, and in particular upadacitinib, in the treatment of recalcitrant DGA.

• #51 Granuloma Annulare – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459377/

  Although the lesions of granuloma annulare usually regress, they tend to recur. For this reason, and for cosmetic reasons, treatment sometimes is indicated. Physicians try many therapies, but there is little research-based evidence to support them. […] Despite the lack of evidence, experts agree that intralesional steroid injection is first-line therapy for lesions of granuloma annulare. There are reports of improvement after certain types of trauma to the lesions such as biopsy, pricking, incision, and cryotherapy. Phototherapy has shown promising results in some studies. There are reports of success with both excimer laser and pulsed dye laser. Hydroxychloroquine has shown success in a few small studies and reports. Although more evidence is needed to prove efficacy, some researchers believe that hydroxychloroquine should be first-line therapy for generalized granuloma annulare. Tumor necrosis factor-alpha inhibitors have shown efficacy in treating generalized and recalcitrant granuloma annulare. However, as mentioned above, there are reports of TNF-alpha inhibitors triggering or exacerbating the disease, so more research is needed to weigh the risks and the benefits of using TNF-alpha inhibitors to treat this disease. Physicians have also tried surgical excision, but lesions tend to recur. […] In addition to the therapy mentioned above, vitamin E, isotretinoin, tetracyclines, intralesional interferons, topical imiquimod, niacinamide, oral calcitriol, dapsone, hydroxyurea, topical tacrolimus, clofazimine, and rifampin have been tried and reported to be effective in small studies.

• #52 Treatment of Widespread Granuloma Annulare with Adalimumab: A Case Report | JCAD – The Journal of Clinical and Aesthetic Dermatology

  https://jcadonline.com/treatment-of-widespread-granuloma-annulare-with-adalimumab-a-case-report/

  The authors report a case of widespread granuloma annulare that was resistant to multiple systemic therapies, but responded rapidly to a short course of adalimumab. […] Often the only drug that is effective in severe disease is an oral corticosteroid, which is unsuitable for long-term use. […] The authors report the case of a woman with widespread GA who had an excellent response to adalimumab. […] Adalimumab was added to methotrexate 15mg/week according to the established psoriasis regimen of two shots of 40mg initially followed by 40mg every two weeks. Improvement was noted at one week, which continued for six weeks until the patient was clear. Methotrexate was discontinued. Adalimumab was continued for one month and then stopped. Two months later, the patient remained clear and was off all medication.

• #53 Treatment of Widespread Granuloma Annulare with Adalimumab: A Case Report | JCAD – The Journal of Clinical and Aesthetic Dermatology

  https://jcadonline.com/treatment-of-widespread-granuloma-annulare-with-adalimumab-a-case-report/

  Tumor necrosis factor (TNF) inhibitors have occasionally been reported to be effective in granulomatous disease. […] The mechanism by which anti-TNF therapy works in granulomatous disease is uncertain, but is likely linked to the ability of adalimumab and infliximab to lyse granulomas in tuberculosis and Crohns disease because of its ability to activate complement when bound to a granuloma cell surface that is expressing TNF.

• #54 Diagnosis and Management of Granuloma Annulare | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1729.html

  Systemic therapy is required for disseminated granuloma annulare, and many different treatments have been proposed. […] The possible benefit of treatment, which is unclear given the lack of clinical trials, must be balanced against the significant toxicities of most of these treatments. […] Dapsone is an antibiotic commonly used for dermatitis herpetiformis or Hansen’s disease. It has been reported to be effective in managing disseminated granuloma annulare. […] Isotretinoin (Accutane) is better known for treating severe acne, but it has been shown to be effective in treating granuloma annulare in numerous case reports. […] Antimalarial agents, including hydroxychloroquine (Plaquenil) and chloroquine (Aralen), have been used in the treatment of granuloma annulare. […] Effective use of cyclosporine (Sandimmune) has been reported in individual patients.

• #55 Diagnosis and Management of Granuloma Annulare | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1729.html

  Niacinamide has been used and is reasonably safe, even at high doses. […] In recent case reports, topical tacrolimus and pimecrolimus had positive outcomes. […] Infliximab (Remicade), a tumor necrosis factor B inhibitor, demonstrated a positive outcome in a patient with recalcitrant disseminated granuloma annulare. […] Granuloma annulare is difficult to treat clinically; reassurance that the condition will self-resolve may be the best option.

• #56 Granuloma Annulare Treatment & Management: Medical Care, Complications

  https://emedicine.medscape.com/article/1123031-treatment

  Piaserico et al reported success with using methyl aminolevulinate photodynamic therapy to treat long-standing generalized GA. […] In a report involving six patients with GA that was refractory to standard treatment, Marcus et al described the use of combination therapy with rifampin 600 mg, ofloxacin 400 mg, and minocycline hydrochloride 100 mg once monthly for 3 months. […] Other anecdotal reports and small series have described successful systemic treatment with dapsone, steroids, pentoxifylline, cyclosporine, fumaric esters, interferon gamma, potassium iodide, nicotinamide, etanercept, infliximab, adalimumab, Janus kinase (JAK) inhibitors, apremilast, and tapinarof cream.

• #57 Monthly rifampicin, ofloxacin, and minocycline therapy for generalized and localized granuloma annulare – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/monthly-rifampicin-ofloxacin-and-minocycline-therapy-for-generalized-and-localized-granuloma-annulare/

  All six patients were successfully treated with 4-8 pulses of monthly ROM. […] Treatment with pulses of once monthly ROM caused complete resolution of lesions in both localized and generalized granuloma annulare, even in cases recalcitrant to conventional therapy. […] ROM pulses appears to be a highly effective, simple, non-invasive, less costly, and safe alternative in treating both forms of granuloma annulare.

• #58 What Is Granuloma Annulare And How Can I Get Rid of It? | The People’s Pharmacy

  https://www.peoplespharmacy.com/articles/what-is-granuloma-annulare-and-how-can-i-get-rid-of-it

  Doctors do not know what causes granuloma annulare, and there is no accepted medical cure (American Family Physician, Nov. 15, 2006). […] For the other half, when GA becomes chronic, physicians may sometimes prescribe powerful immune-suppressing drugs known as biologics (International Journal of Dermatology, May 2019). […] Doctors sometimes prescribe another medicine called pentoxyfilline (Journal of Dermatological Treatment, June 2021). […] Some readers have reported success applying vinegar to the spots. Others tell us that the antifungal cream Vagisil can help, even though GA is not supposed to be a fungal infection. […] As mentioned above, some people find that Vagisil with resorcinol for vaginal yeast infections is also helpful for GA. Dermatologists don’t have a standard treatment, but pentoxifylline, a drug for peripheral artery disease, shows some promise (Journal of Dermatological Treatment, June 2021).

• #59 Diagnosis and Management of Granuloma Annulare | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1729.html

  Granuloma annulare is a benign skin condition that typically consists of grouped papules in an enlarging annular shape. […] Because localized granuloma annulare is self-limited, no treatment other than reassurance may be necessary. […] Treatment recommendations are based on the patho-physiology of the disease, expert opinion, and case reports only. Liquid nitrogen, injected steroids, or topical steroids under occlusion have been recommended for treatment of localized disease. […] Disseminated granuloma annulare may be treated with one of several systemic therapies such as dapsone, retinoids, niacinamide, antimalarials, psoralen plus ultraviolet A therapy, fumaric acid esters, tacrolimus, and pimecrolimus. […] Consultation with a dermatologist is recommended because of the possible toxicities of these agents.

• #60 Diagnosis and Management of Granuloma Annulare | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1729.html

  Localized granuloma annulare is self-limited and asymptomatic and usually does not require treatment. […] Options for treatment of localized granuloma annulare include liquid nitrogen, injected steroids, and topical steroids. […] Treatment for disseminated granuloma annulare should be undertaken in consultation with a dermatologist; options include dapsone, retinoids, antimalarial drugs, tacrolimus (Protopic), and pimecrolimus (Elidel). […] Medical literature contains limited reliable information on the treatment of granuloma annulare. […] Because localized granuloma annulare is self-limited and asymptomatic, treatment usually is not necessary. […] Nevertheless, many patients remain troubled by the appearance and persist in seeking treatment. For patients insisting on treatment, options include intralesional corticosteroid injection with 2.5 to 5.0 mg per mL triamcinolone (Aristocort) into the elevated border, topical corticosteroids under occlusion, cryotherapy, and electrodesiccation.

• #61 Granuloma Annulare Treatment & Management: Medical Care, Complications

  https://emedicine.medscape.com/article/1123031-treatment

  Localized granuloma annulare (GA) is not often symptomatic, and it has a tendency towards spontaneous resolution. Reassurance is often all that is necessary. Painful or disfiguring lesions have been treated by various methods, though the level of evidence supporting these methods has been low. […] Localized lesions have been treated with potent topical corticosteroids with or without occlusion for 4-6 weeks, as well as with intralesional corticosteroids with varying total doses of steroid. […] Cryotherapy using liquid nitrogen or nitrous oxide as refrigerants was shown in a prospective uncontrolled trial to be an effective treatment for localized GA. […] Hyperthermic 20 MHz high-intensity focused ultrasound (HIFU) has been suggested as a potentially promising means of treating GA that may cause less skin necrosis than cryotherapy.

• #62 Diagnosis and Management of Granuloma Annulare | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1729.html

  Localized granuloma annulare is self-limited and asymptomatic and usually does not require treatment. […] Options for treatment of localized granuloma annulare include liquid nitrogen, injected steroids, and topical steroids. […] Treatment for disseminated granuloma annulare should be undertaken in consultation with a dermatologist; options include dapsone, retinoids, antimalarial drugs, tacrolimus (Protopic), and pimecrolimus (Elidel). […] Medical literature contains limited reliable information on the treatment of granuloma annulare. […] Because localized granuloma annulare is self-limited and asymptomatic, treatment usually is not necessary. […] Nevertheless, many patients remain troubled by the appearance and persist in seeking treatment. For patients insisting on treatment, options include intralesional corticosteroid injection with 2.5 to 5.0 mg per mL triamcinolone (Aristocort) into the elevated border, topical corticosteroids under occlusion, cryotherapy, and electrodesiccation.

• #63 Granuloma Annulare Treatment & Management: Medical Care, Complications

  https://emedicine.medscape.com/article/1123031-treatment

  Localized granuloma annulare (GA) is not often symptomatic, and it has a tendency towards spontaneous resolution. Reassurance is often all that is necessary. Painful or disfiguring lesions have been treated by various methods, though the level of evidence supporting these methods has been low. […] Localized lesions have been treated with potent topical corticosteroids with or without occlusion for 4-6 weeks, as well as with intralesional corticosteroids with varying total doses of steroid. […] Cryotherapy using liquid nitrogen or nitrous oxide as refrigerants was shown in a prospective uncontrolled trial to be an effective treatment for localized GA. […] Hyperthermic 20 MHz high-intensity focused ultrasound (HIFU) has been suggested as a potentially promising means of treating GA that may cause less skin necrosis than cryotherapy.

• #64 Granuloma Annulare Treatment & Management: Medical Care, Complications

  https://emedicine.medscape.com/article/1123031-treatment

  Laser therapy using multiple different modalities, including pulsed dye and excimer, has been successfully used for both localized and generalized GA. […] Anecdotal reports of therapeutic efficacy in both localized and generalized GA have been published for tacrolimus and pimecrolimus, as well as for imiquimod cream. […] Over the past two decades, success with the use of ultraviolet (UV)-B (mostly narrowband UV-B) therapy, a relatively harmless treatment compared with the alternatives, has made this a first-line option for generalized GA. […] There is evidence to support the use of phototherapy with oral psoralen and UV-A (PUVA) as first-line options for generalized GA. […] On the basis of a number of case reports, isotretinoin may be a first-line option. […] Antimalarials may also be quite effective, as suggested by a large case series and individual reports.

• #65 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Cryotherapy has been shown to lead to an 81% resolution rate for localized disease. […] Generalized GA may require systemic therapy, although application of topical steroids to lesions affecting a broad area may still be possible. […] Prednisone can be effective, but the need for prolonged treatment, with the associated side effects, may outweigh the utility. […] Similarly, oral retinoids such as isotretinoin at 40mg daily for 8-12 weeks may lead to a 90% response rate, but is associated with liver and lipid abnormalities. […] Photodynamic therapy with 5-aminolevulinic acid or PUVA can be effective, but may not be practical due to the need for frequent treatments. […] There have been multiple reports of other modalities being used, with varying success; however, they consist of small case studies or retrospective reviews with small numbers of patients. Examples of such medications include dapsone and hydroxychloroquine. […] All treatments for GA have potential side effects, and therefore the risk must be balanced against the benefit. Since this is generally an asymptomatic self-limited disease, reassurance may be the best option. In general, topical modalities can be effective and should be thought of as first line.

• #66 Granuloma Annulare Treatment & Management: Medical Care, Complications

  https://emedicine.medscape.com/article/1123031-treatment

  Laser therapy using multiple different modalities, including pulsed dye and excimer, has been successfully used for both localized and generalized GA. […] Anecdotal reports of therapeutic efficacy in both localized and generalized GA have been published for tacrolimus and pimecrolimus, as well as for imiquimod cream. […] Over the past two decades, success with the use of ultraviolet (UV)-B (mostly narrowband UV-B) therapy, a relatively harmless treatment compared with the alternatives, has made this a first-line option for generalized GA. […] There is evidence to support the use of phototherapy with oral psoralen and UV-A (PUVA) as first-line options for generalized GA. […] On the basis of a number of case reports, isotretinoin may be a first-line option. […] Antimalarials may also be quite effective, as suggested by a large case series and individual reports.

• #67 Successful Treatment of Disseminated Granuloma Annulare With Narrowband UV-B Phototherapy | Actas Dermo-Sifiliográficas

  https://actasdermo.org/en-successful-treatment-disseminated-granuloma-annulare-articulo-S157821901500027X

  Disseminated granuloma annulare (DGA) is an inflammatory disease that tends to follow a chronic course and is resistant to multiple treatments. […] The patient was prescribed several cycles of oral prednisone (30mg per day in decreasing doses for periods of 6 weeks) and topical corticosteroids (15 days) with no improvement. […] The patient underwent narrowband ultraviolet-B (NB-UVB) phototherapy 3 times per week for 2.5 months, following a dose escalation protocol for skin phototype II. […] This is the second reported case of DGA treated with NB-UVB. […] A lack of evidence-based treatment guidelines makes DGA treatment challenging for the dermatologist. […] Among the most commonly used treatments are topical, oral, intralesional, and intramuscular corticosteroids, biological agents, surgery, laser treatment, and phototherapy.

• #68 Granuloma Annulare – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/granuloma-annulare

  Treatment is with topical or intralesional corticosteroids, topical tacrolimus, cryotherapy, and phototherapy. […] For localized lesions, sometimes potent topical or intralesional corticosteroids, topical tacrolimus, cryotherapy, and/or phototherapy. […] For widespread lesions, sometimes hydroxychloroquine, isotretinoin, dapsone, and/or cyclosporine. […] Usually no treatment is necessary; spontaneous resolution is common but may take years. For patients with more widespread or bothersome lesions, quicker resolution may be desired. […] For localized lesions, high-strength topical or intralesional corticosteroids, topical tacrolimus, cryotherapy, and various forms of phototherapy may be used. […] For widespread lesions, hydroxychloroquine, isotretinoin, dapsone, and cyclosporine may be successful.

• #69

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Given the function of Janus kinase (JAK) as a signal transducer and activator of transcription pathway in the development of GA, JAK inhibitors appear to be a promising treatment. […] Over a period of 4 to 8 months, all patients received 5 mg of tofacitinib twice daily. […] The use of JAK inhibitors seems to be a logical course of treatment, given the significance of Janus kinase in the pathophysiology of GA. […] Tofacitinib, upadacitinib, or baricitinib administration significantly improves lesions while displaying nearly no side effects.

• #70 Granuloma Annulare: Causes, Symptoms, Treatment | Doctor

  https://patient.info/doctor/granuloma-annulare-pro

  Oral steroids. […] Dapsone. […] Ciclosporin and methotrexate. […] Antibiotic combinations such as minocycline plus rifampicin plus ofloxacin. […] Antimalarials, such as hydroxychloroquine. […] Isotretinoin. […] The TNF inhibitor infliximab – may be useful in recalcitrant cases. Adalimumab has also been reported to be effective. […] With subcutaneous lesions in children, the best management is reassurance, although they can be excised surgically. Treatment of perforating lesions is disappointing.

• #71 Granuloma annulare

  https://dermnetnz.org/topics/granuloma-annulare

  In most cases granuloma annulare, does not require treatment because the patches disappear by themselves in a few months, leaving no trace. However, sometimes they persist for years. Treatment is not curative but may help individual lesions. […] Options to consider include: Topical corticosteroid ointment under occlusion, Intralesional steroid injections, Destruction by cryotherapy or laser ablation, Imiquimod cream, Topical calcineurin inhibitors (tacrolimus and pimecrolimus). […] Systemic therapy may be considered in widespread granuloma annulare. The following treatments have been reported to help at least some cases of disseminated granuloma annulare. None of these can be relied upon to clear it, and there are potential adverse effects. Systemic steroids, Isotretinoin, Methotrexate, Potassium iodide, Dapsone, Hydroxychloroquine, Pentoxifylline, Allopurinol (note: allopurinol has also be cited as a cause of disseminated granuloma annulare), Combination of antibiotics once monthly: rifampicin, ofloxacin, minocycline, Photochemotherapy (PUVA), UVA1 phototherapy (not available in New Zealand), Photodynamic therapy, Ciclosporin, Biologics particularly TNF inhibitors such as adalimumab and infliximab, Experimentally, oral and topical Janus kinase (JAK) inhibitors including tofacitinib.

• #72 Granuloma Annulare Treatment & Management: Medical Care, Complications

  https://emedicine.medscape.com/article/1123031-treatment

  Piaserico et al reported success with using methyl aminolevulinate photodynamic therapy to treat long-standing generalized GA. […] In a report involving six patients with GA that was refractory to standard treatment, Marcus et al described the use of combination therapy with rifampin 600 mg, ofloxacin 400 mg, and minocycline hydrochloride 100 mg once monthly for 3 months. […] Other anecdotal reports and small series have described successful systemic treatment with dapsone, steroids, pentoxifylline, cyclosporine, fumaric esters, interferon gamma, potassium iodide, nicotinamide, etanercept, infliximab, adalimumab, Janus kinase (JAK) inhibitors, apremilast, and tapinarof cream.

• #73 Treatment of disseminated granuloma annulare with pulse therapy upadacitinib

  https://escholarship.org/uc/item/8v94f6ks

  Granuloma annulare (GA) is an idiopathic inflammatory skin condition with a chronic and unpredictable course. […] Although localized GA is usually cleared with topical or systemic corticosteroids, generalized GA is often difficult to treat owing to the lack of treatment options and recurrence with treatment. […] Recent evidence has helped to elucidate the etiology behind GA, with growing confirmation for the use of JAK inhibitors as a possible treatment for GA. […] We present a 61-year-old woman with recalcitrant GA who responded successfully to pulse therapy upadacitinib, a JAK1 inhibitor. […] Our findings demonstrate the utility of this alternative and practical treatment strategy that may reduce the cumulative toxicity of upadacitinib and optimize its risk/benefit ratio.

• #74 Treatment of Recalcitrant Generalized Granuloma Annulare With Adalimumab – JDDonline – Journal of Drugs in Dermatology

  https://jddonline.com/articles/treatment-of-recalcitrant-generalized-granuloma-annulare-with-adalimumab-S1545961611P1466X

  Granuloma annulare is a benign, usually self-limited, dermatosis of unknown cause. […] The treatment of generalized granuloma annulare can be challenging. […] Adalimumab may be an additional option in the treatment of recalcitrant forms of granuloma annulare. […] The treatment of GGA can be challenging. Systemic steroids can often benefit patients; however high doses are required and usually patients relapse after stopping treatment. […] Other systemic treatments include nicotinamide, PUVA therapy, UVA1, dapsone, pentoxifylline, systemic retinoids, cyclosporine, alkylating agents, and antimalarials. […] Treatment with adalimumab was started, with a subcutaneous injection 80 mg at week 0 and then 40 mg every other week at week 1. […] A rapid response to treatment was observed, and at week 4 most of the lesions had showed a remarkable regression. […] The use of TNF- inhibitors (infliximab, adalimumab and etanercept) in the treatment of recalcitrant GGA has been reported, showing an effective and rapid response.

• #75 Granuloma Annulare Treatment & Management: Medical Care, Complications

  https://emedicine.medscape.com/article/1123031-treatment

  Piaserico et al reported success with using methyl aminolevulinate photodynamic therapy to treat long-standing generalized GA. […] In a report involving six patients with GA that was refractory to standard treatment, Marcus et al described the use of combination therapy with rifampin 600 mg, ofloxacin 400 mg, and minocycline hydrochloride 100 mg once monthly for 3 months. […] Other anecdotal reports and small series have described successful systemic treatment with dapsone, steroids, pentoxifylline, cyclosporine, fumaric esters, interferon gamma, potassium iodide, nicotinamide, etanercept, infliximab, adalimumab, Janus kinase (JAK) inhibitors, apremilast, and tapinarof cream.

• #76

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Granuloma annulare (GA) is a benign, inflammatory granulomatous skin condition that can present as localized, disseminated, subcutaneous, perforating and a few other less prevalent subtypes. […] This review was conducted to evaluate the latest published studies and outline the options for GA treatment. […] Multiple treatment modalities for GA have been reported, including topical and oral treatment along with many procedures, wherefrom phototherapy remains the most well-studied option. […] Recently new studies have identified Th1, Th2, and JAK-STAT pathways dysregulation in GA skin lesions, and subsequently, promising effects have been reported with Th1, Th2, and JAK-STAT targeting therapy for GA. […] There is still no gold standard for clinical management of GA. […] Therapeutic approach may vary depending on the clinical subtype of GA, necessitating individualization based on patients preferences, possible side effects and risk-benefit ratio.

• #77 Diagnosis and Management of Granuloma Annulare | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1729.html

  Niacinamide has been used and is reasonably safe, even at high doses. […] In recent case reports, topical tacrolimus and pimecrolimus had positive outcomes. […] Infliximab (Remicade), a tumor necrosis factor B inhibitor, demonstrated a positive outcome in a patient with recalcitrant disseminated granuloma annulare. […] Granuloma annulare is difficult to treat clinically; reassurance that the condition will self-resolve may be the best option.

• #78 Granuloma annulare: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/granuloma-annulare-treatment

  Some cases of granuloma annulare can be stubborn. The first treatment you try may not work. For this reason, dermatologists use different treatments that can help clear the skin. […] While granuloma annulare is not an infection, an antibiotic may help be helpful for some people. […] Before using a treatment, your dermatologist will weigh the risk of possible side effects against the effects that granuloma annulare has on your quality of life. […] No one treatment has proven effective for everyone. Some people need to try different options before finding treatment that works.

• #79 Successful Treatment of Disseminated Granuloma Annulare With Narrowband UV-B Phototherapy | Actas Dermo-Sifiliográficas

  https://actasdermo.org/en-successful-treatment-disseminated-granuloma-annulare-articulo-S157821901500027X

  NB-UVB phototherapy, with an emission spectrum of 311-313nm, has been used for many years to treat psoriasis, and poses a lower risk of erythema and carcinogenicity than broadband UVB. […] Several variables should be considered when selecting systemic treatment for DGA, including the patients baseline blood evaluations, comorbidities, interactions with other drugs, potential adverse effects, and prior treatments.

• #80 Granuloma annulare: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/granuloma-annulare-treatment

  Some cases of granuloma annulare can be stubborn. The first treatment you try may not work. For this reason, dermatologists use different treatments that can help clear the skin. […] While granuloma annulare is not an infection, an antibiotic may help be helpful for some people. […] Before using a treatment, your dermatologist will weigh the risk of possible side effects against the effects that granuloma annulare has on your quality of life. […] No one treatment has proven effective for everyone. Some people need to try different options before finding treatment that works.

• #81 Granuloma Annulare: Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/17874-granuloma-annulare

  Your healthcare provider will use a special laser to target your affected skin. […] Your healthcare provider may recommend vitamin E tablets if you dont respond to other treatment options. […] For some people, granuloma annulare is challenging to treat. You may need to try several therapies before finding what works best for you. […] Changes to your diet may help improve granuloma annulare. […] The following can help improve your skins overall health: […] Apply a moisturizing cream or ointment immediately after drying your skin to help seal in the moisture.

• #82 Granuloma annulare: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/granuloma-annulare-treatment

  Some cases of granuloma annulare can be stubborn. The first treatment you try may not work. For this reason, dermatologists use different treatments that can help clear the skin. […] While granuloma annulare is not an infection, an antibiotic may help be helpful for some people. […] Before using a treatment, your dermatologist will weigh the risk of possible side effects against the effects that granuloma annulare has on your quality of life. […] No one treatment has proven effective for everyone. Some people need to try different options before finding treatment that works.

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