Perforating granuloma annulare: Response to treatment with isotretinoin

Abstract

A 21-year-old woman had a painful eruption on the hands, elbows, and knees. She reported the occasional spontaneous discharge of viscous fluid, followed by crusting. Response to treatment with potent topical steroids had been poor. Examination revealed numerous 2 to 8 mm umbilicated papules (Fig. 1); many of the lesions had coalesced and others were ulcerated. A punch biopsy of a papule from the hands demonstrated transepidermal elimination of degenerate mutinous collagen bundles, and granulomas with palisading lymphoid cells and histiocytes. For 2 years the patient was treated with topical 0.05% clobetasol propionate under occlusion, repeated intralesional injections with triamcinolone, and cryotherapy with poor response. A trial of isotretinoin (0.75 mg/kg/ day) was begun because of recent reports of the successful use of retinoids in classic granuloma annulare (GA) .l, 2 Near-complete resolution of the papulcs was seen within 10 weeks with dramatic relief of pain (Fig. 2). Cessation of treatment resulted in recurrence of some lesions during a 6-month period. Treatment with isotretinoin (0.5 mg/kg/day) was begun with satisfactory control of the disease and fewer side effects. Treatment was stopped after 4 months because of the patient’s desire to become pregnant. Although a few lesions have persisted, no relapse has been observed 6 months later.