Generalized Granuloma Annulare Research Articles

Granuloma annulare and Kaposi sarcoma as the onset of HIV in a patient without risk behaviour

This case report describes a 34-year-old, HIV-positive, female referred to the hospital for treatment. The patient had widespread Kaposi sarcoma and a very low CD4-number. Prior to diagnosis, she had generalized granuloma annulare for six months, an incident of herpes zoster, and no sexual risk behaviour. In young cases with generalized granuloma annulare, an underlying immunodeficiency should be suspected and an HIV-test performed. Furthermore, HIV is found in all population groups and not only in classical risk groups.

Narrowband Ultraviolet B Phototherapy for Generalized Granuloma Annulare: Real-Life Experience and Review of the Literature.

Generalized granuloma annulare (GA) is an uncommon noninfectious granulomatous dermatitis. Phototherapy is often considered first-line therapy, with more evidence for psoralen ultraviolet A than narrowband ultraviolet B (NB-UVB). We aimed to evaluate the effectiveness and safety of NB-UVB in generalized GA and to review the literature. In this observational, retrospective study, 11 patients with generalized GA who received NB-UVB between 2013 and 2023 were evaluated. Data from the patients were obtained from the phototherapy unit and clinical follow-up forms. Eleven patients, 10 (90.9%) female and 1 (9.1%) male were included in the study. The mean age of the patients was 57.6 ± 7.9 years. The mean disease duration was 26.9 ± 27.9 weeks. Three (27.2%) of the patients had interstitial GA. All patients showed improvement: NB-UVB therapy resulted in complete response in 18.2% of the patients and partial response in 81.8%. The mean number of NB-UVB sessions was 36.4 ± 13.8. The mean cumulative dose was 37.1 ± 25.6 J/cm2. There was no significant difference in the mean number of sessions and cumulative dose according to clinical response (P > .05). NB-UVB was extremely well tolerated. After phototherapy, patients were followed for at least 6 months; no relapses were observed. NB-UVB is an effective and safe treatment option in generalized GA.

Tofacitinib in a case of generalized granuloma annulare: A two-year follow-up of relapse and remission

Tofacitinib in a case of generalized granuloma annulare: A two-year follow-up of relapse and remission

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

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

Successful Treatment of Refractory Generalized Granuloma Annulare with Upadacitinib

Successful Treatment of Refractory Generalized Granuloma Annulare with Upadacitinib

Generalized granuloma annulare in an infant clinically manifested as papules and atrophic macules: A case report

Generalized granuloma annulare in an infant clinically manifested as papules and atrophic macules: A case report

48 JAK1/2 pathway-specific treatment of generalized granuloma annulare with baricitinib

48 JAK1/2 pathway-specific treatment of generalized granuloma annulare with baricitinib

Results of a treatment algorithm for generalized granuloma annulare

Results of a treatment algorithm for generalized granuloma annulare

44498 Progression of Cutaneous Involvement in Generalized Granuloma Annulare over Time

44498 Progression of Cutaneous Involvement in Generalized Granuloma Annulare over Time

A Case of Generalized Granuloma Annulare Induced by Intravesical Bacillus Calmette–Guerin Immunotherapy

A Case of Generalized Granuloma Annulare Induced by Intravesical Bacillus Calmette–Guerin Immunotherapy

Apremilast in the Management of Generalized Granuloma Annulare: A Case Series

Background: Granuloma annulare is a difficult disease to treat and can lead to anxiety and frustration for both patients and providers. The pathogenesis of granuloma annulare is unknown, resulting in few thoroughly studied or consistently effective treatments.
 Objective: 1) To discuss whether treatment with apremilast could lead to improvement or resolution of generalized granuloma annulare. 2) To explore the possible pathogenesis of granuloma annulare and the mechanism of apremilast in treating this disease.
 Methods: A case series was used to study the clinical response of 6 patients with a history of recalcitrant generalized granuloma annulare taking apremilast 30mg twice daily.
 Results: Two patients achieved complete clearance of their disease without recurrence while the remaining 4 patients achieved significant improvement in lesion number, induration, and erythema.
 Limitations: This is a small case series and larger, controlled trials with long-term follow-up are needed. There is no objective method for evaluating the extent of disease improvement in granuloma annulare. Furthermore, our patients used concomitant topical and intralesional steroids while on apremilast.
 Conclusion: This case series illustrates a novel therapy, apremilast, a phosphodiesterase-4 inhibitor, in the treatment of patients with generalized granuloma annulare and explores possible mechanisms behind the success of this treatment.

PSAT353 Can Generalized Granuloma Annulare occur in patients with Graves’ disease?

Abstract Introduction Granuloma annulare (GA) is a benign self-limiting dermatosis, typically characterized by an annular arrangement of erythematous or flesh-colored papules, affecting patients of all ages. An association between GA and autoimmune diseases (including autoimmune thyroiditis) has been reported in the literature thus suggesting that GA belongs to the spectrum of autoimmune diseases. However, only a few case reports described the unusual association of localized GA with hyperthyroidism. The definitive correlation between thyroid disease and GA hasn't been established. It was suggested that there is a common immunogenic predisposition or that both diseases share a common pathway. We present a rare case of generalized granuloma annulare in a patient with Graves’ disease. Case report A 52-year-old African American female with a past medical history of Graves’ disease with mild Graves’ ophthalmopathy was referred to the endocrinology clinic. She was diagnosed with Graves’ disease seven years ago and was medically managed ever since. Initially, she was treated with a high dose of methimazole however, for the past six years, she was on a stable dose of methimazole 5 mg daily. Two years following diagnosis of Graves’ disease, she developed serpiginous non-pruritic erythematous skin papules and patches in the right upper arm which slowly progressed over the course of years to involve bilateral inner thighs and under the breasts. She was evaluated by dermatology at that time and was empirically treated with a topical antifungal agent without any significant improvements. After establishing care with us, there was suspicion of methimazole-induced ANCA vasculitis or other autoimmune diseases. Extensive rheumatological workup including ANCA level was performed with negative results. Since her thyroid function tests (TSH and free T4) were normal on a low dose of methimazole for an extended period, we discontinued methimazole, however, skin rash didn't improve. The patient was then evaluated by dermatology and was diagnosed with GA based on clinical judgment. She was subsequently treated with an extended course of triple antibiotics therapy using rifampin, ofloxacin, and minocycline for 5 months with significant improvement of the skin rash. Currently, the patient has been off methimazole for 12 months and off triple antibiotic for 4 months with no recurrence of symptoms. Conclusion Although rare, generalized granuloma annulare can be seen in patients with autoimmune thyroid disease including Graves’ disease. Hence, endocrinologists should be aware of the different skin manifestations which can be seen in patients with autoimmune thyroid disease. Further studies are necessary to clarify the association of GA with autoimmune thyroid disease. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

34266 Is generalized granuloma annulare truly associated with diabetes mellitus, hyperlipidemia, thyroid disorders, and malignancy? A systematic review

Objective: Generalized granuloma annulare (GGA) is a rare subtype of granuloma annulare (GA) characterized by its benign, yet chronic recurrent course. Several studies have debated GGA’s association with underlying systemic disease such as diabetes mellitus (DM), dyslipidemia (DLD), malignancy, and thyroid disorders (TD). Our objective was to evaluate the association between GGA and systemic diseases. Methods: The databases PubMed, Embase, and Cochrane Library were searched on June 15, 2021, for “generalized or disseminated granuloma annulare.” Results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results: A total of 579 studies were screened for inclusion, yielding 194 studies with 934 patients. The mean age was 51.2 years, and 68.3% of patients were female.The 3 most common associated systemic conditions were DLD (14.6%, n = 136/934), DM (14.5%, n = 135/934), and TD (9.1%, n = 85/934). A total of 93 malignancies (10.0%, n = 93/934) were reported, 69 being non-hematologic malignancies. In total, 35.5% (n = 33/93) of patients had paraneoplastic GGA. Conclusion: Our evidence-based review showed much lower prevalence of DLD, DM, and TD than previous studies. Moreover, only 15 patients experienced resolution of GGA with appropriate management of these comorbidities. Therefore, only a small percentage of patients seem to have a true association of GGA with systemic disease. However, our findings revealed paraneoplastic GGA in 35.5% of patients with underlying malignancy. Therefore, we advocate that it may be beneficial to update age-appropriate cancer screening in individuals with refractory or severe GGA, and history or signs of underlying malignancy.

33823 Update on systemic treatment options for generalized granuloma annulare

Generalized granuloma annulare (GGA) can be difficult to treat. Our institution previously evaluated the efficacy of methotrexate, hydroxychloroquine, and dapsone for GGA. We compared that to unpublished data on pentoxifylline. Institutional review board approval was obtained to retrospectively review records of GGA patients who underwent systemic therapy. All cases were generalized and biopsy-proven. Outcomes were categorized as complete clearance, partial response (fewer, flattened, faded lesions), and no response.

34274 Systematic review of efficacy of treatment options for generalized granuloma annulare

Objective: Generalized granuloma annulare (GGA) is a rare subtype of granuloma annulare (GA) characterized by its benign, yet chronic recurrent course. Currently, evidence-based treatment guidelines are lacking. Therefore, our objective was to conduct a true systematic review to summarize and evaluate the best therapeutic options for GGA.

Malignancy-Associated Generalized Granuloma Annulare in a Japanese Patient with Stomach Cancer and Diabetes Mellitus

Granuloma annulare is a benign granulomatous dermatosis with variable clinical presentation. It is of unknown origin and results in erythematous, brown, or skin-colored annular plaques usually found over boney surfaces on the extremities. The main variants are localized granuloma annulare, subcutaneous granuloma annulare, perforating granuloma annulare, and generalized granuloma annulare. Systemic diseases proposed to have an association with granuloma annulare include diabetes mellitus, dyslipidemia, hypothyroidism, and various malignancies. Cohen [1] coined the term ‘malignancy-associated granuloma annulare’ to describe a form of granuloma annulare that is temporally associated with a malignant process, in which the onset of granuloma annulare coincides with the discovery of a previously unsuspected neoplasm or metastatic disease, and the course of the granuloma annulare also parallels that of the tumor. We present a Japanese patient with malignancy-associated generalized granuloma annulare as the first manifestation of stomach cancer based on diabetes mellitus.

Pentoxifylline in the treatment of generalized granuloma annulare: A report of three cases

Pentoxifylline in the treatment of generalized granuloma annulare: A report of three cases

An evidence-based approach for malignancy-associated and paraneoplastic generalized granuloma annulare

To the Editor: Generalized granuloma annulare (GGA) is a rare subtype of granuloma annulare associated with an underlying systemic disease and malignancy.1-4 Our objective was to conduct an evidence-based review evaluating the association between GGA and malignancy.

26611 Apremilast in the management of generalized granuloma annulare: A case series

This case series evaluates four female patients of ages 29, 61, 66, and 73 years old with a history of recalcitrant generalized granuloma annulare (GA) treated with oral apremilast. All four had previously failed numerous therapies for GA including topical and intralesional steroids, hydroxychloroquine, and narrowband ultraviolet B light phototherapy. Generalized granuloma annulare is a difficult disease to treat and can lead to anxiety and frustration for both patients and providers. The etiopathogenesis of GA is unknown, and as such the disease has few treatments that have been thoroughly studied or consistently effective. This case series illustrates a novel therapy, apremilast, a phosphodiesterase-4 inhibitor, in the treatment of four patients with generalized GA resulting in improvement of their skin disease. The possible etiopathogenesis of GA, as well as the mechanism behind the efficacy of apremilast in treating GA, are both explored. However, larger, controlled trials of apremilast in patients with GA are needed to further evaluate the efficacy of apremilast in the treatment in GA.

Methotrexate for generalized granuloma annulare: A 60% response rate in a retrospective case series of 15 patients

Methotrexate for generalized granuloma annulare: A 60% response rate in a retrospective case series of 15 patients