Cyclosporine in the treatment of generalized granuloma annulare

Abstract

A 56-year-old man had numerous small papules, some in an annular pattern, on the trunk, upper and lower extremities , and neck that had appeared gradually during the last 6 months. Histologic examination showed a palisading granuloma of the papillary dermis with a predominantly lymphohistiocytic infiltrate; there was no fragmentation of elastic fibersor elastophagocytosis. Direct immunofluorescence testing results were negative. GGA was diagnosed. Blood glucose, cholesterol, uric acid, immunoglobulin, and complement levelswere normal. Treatment with diaminodiphenylsulfone (DDS), 100 mg/day, was started. After 12 weeks the eruption was unchanged and treatment was stopped. With the informed consent of the patient , treatment with cyclosporine, 6 mgjkgjday, was started. Cyclosporine trough levels and serum creatinine levels were monitored twice monthly throughout treatment. After 2 weeks the papules began to flatten, and the erythema was reduced. The lesions had virtually disappeared after 30 days. The dose of cyclosporine was decreased to 3 mg/kg /day, and therapy was continued for another 90 days, at the end of which time complete clearing was obtained (Figs. I and 2). During the following year no recurrence was noted.