Treatment Of Granuloma Annulare Research Articles

Therapeutic Options for Granuloma Annulare: An Updated Review

Granuloma annulare (GA) is a type of non-infectious skin disease that involves the formation of granulomas, or small areas of inflammation, on the skin. It is characterized by annular lesions on the surface of the skin and may be linked to systemic diseases such as diabetes, hyperlipidemia, and thyroid disease. The cause and mechanism of GA are not yet fully understood. In contrast to the generalized type, which is more persistent and less receptive to treatment, the localized version usually cures itself after two years. The most common form of treatment for localized GA includes topical and intralesional triamcinolone. Corticosteroid-resistant GA may require second-line therapies, including apremilast, methotrexate, hydroxychloroquine, dapsone, pentoxifylline, and sulphasalazine. Phototherapy remains a viable option for certain GA patients due to its moderate efficacy and relatively safe profile. This research update comprehensively reviews the available literature on the treatment of GA, as well as the effectiveness and safety of different GA modalities for treatment.

Light- and laser-based treatments for granuloma annulare: A systematic review.

Granuloma annulare (GA) is challenging to treat, especially when generalized. A systematic review to support the use of light- and laser-based treatments for GA is lacking. We performed a systematic review by searching Cochrane, MEDLINE, and Embase. Title, abstract, full-text screening, and data extraction were done in duplicate. Quality appraisal was performed using the Joanna Briggs Institute critical appraisal tool for case series. Thirty-one case series met the inclusion criteria, representing a total of 336 patients. Overall, psoralen ultraviolet light A (PUVA) showed the greatest frequency of cases with complete response (59%, n=77/131), followed by photodynamic therapy (PDT) (52%, n=13/25), ultraviolet light B (UVB)/narrowband UVB (nbUVB)/excimer laser (40%, n=19/47), UVA1 (31%, n=27/86), and lasers (29%, n=8/28). Overall across treatment modalities, higher response rates were seen in localized GA compared to generalized GA. The body of evidence for light- and laser-based treatment of GA is sparse. Our results suggest that PUVA has a high clearance rate for GA but its use may be limited by concerns of carcinogenesis. Although PDT has the second highest clearance rate, adverse effects, small sample sizes, impractical treatment delivery (especially with generalized disease), and long-term concerns of carcinogenesis may limit its use. Although UVB/nbUVB/excimer laser appeared slightly less effective than other light therapies, we recommend UVB/nbUVB/excimer laser therapy as a first-line treatment for patients with generalized GA given wider availability and a favorable long-term safety profile.

Successful Treatment of Granuloma Annulare with Thin-Layered Co2 Laser Ablation

Two clinical cases of successful thin-layered CO2 laser ablation of localized form of granuloma annulare, are presented. Granuloma annulare is a rare dermatosis whose etiology is still unclear. Relation to various systemic diseases is assumed. Non-aesthetic lesions create discomfort, and may impede affected individuals’ social confidence, physical, and psycho-social functioning. In most cases lesions regress spontaneously, and therefore therapeutic minimalism is to be applied. Therapeutic modalities include laser therapy. Reports in literature of GA treatment with PDL, Fractional Thermolysis, as well as excimer laser indicate attempts at treatment of GA are being made not knowing the mechanisms behind etiology of GA. Presented bellow successfully treated cases with thin-layered CO2 laser ablation demonstrate treatment of GA with thin-layered laser ablation as therapeutically effective. The procedure is bloodless, relatively painless and completely aseptic, no postoperative pain. Possible impetiginization is easily avoided. Keywords: Granuloma Annulare; CO2 Laser; Thin-Layered Laser Ablation Abbreviations (CO2 laser) Carbon Dioxide Laser (GA) Granuloma Annulare (PDL) Pulsed Dye Laser (FT) Fractional Thermolysis

Treatment of granuloma annulare and suppression of proinflammatory cytokine activity with tofacitinib

Granuloma annulare (GA) is a common cutaneous inflammatory disorder characterized by macrophage accumulation and activation in skin. Its pathogenesis is poorly understood, and there are no effective treatments. The potential health implications of severe GA are unknown. We sought to better understand GA pathogenesis and evaluate a molecularly targeted treatment approach for this disease. We used single-cell RNA sequencing to study the immunopathogenesis of GA and also evaluated the efficacy of tofacitinib (a Janus kinase 1/3 inhibitor) in 5 patients with severe, long-standing GA in an open-label clinical trial. Using single-cell RNA sequencing, we found that in GA lesions IFN-γ production by CD4+ T cells is upregulated and is associated with inflammatory polarization of macrophages and fibroblasts. In particular, macrophages upregulate oncostatin M, an IL-6 family cytokine, which appears to act on fibroblasts to alter extracellular matrix production, a hallmark of GA. IL-15 and IL-21 production appears to feed back on CD4+ T cells to sustain inflammation. Treatment of 5 patients with recalcitrant GA with tofacitinib inhibited IFN-γ and oncostatin M, as well as IL-15 and IL-21, activity and resulted in clinical and histologic disease remission in 3 patients and marked improvement in the other 2. Inhibition of these effects at the molecular level paralleled the clinical improvement. Evidence of systemic inflammation is also present in some patients with severe GA and is mitigated by tofacitinib. The Janus kinase-signal transducer and activator of transcription pathway is activated in GA, likely in part through the activity of IFN-γ and oncostatin M, and Janus kinase inhibitors appear to be an effective treatment.

Treatment of granuloma annulare and related granulomatous diseases with sulphasalazine: a series of 16 cases.

Granuloma annulare (GA) and the related annular elastolytic giant cell granuloma (AEGCG) and interstitial granulomatous dermatitis (IGD) are idiopathic histiocytic inflammatory disorders, which are frequently recalcitrant to treatment. Evaluate the efficacy of sulphasalazine in treating GA, AEGCG and IGD. Sixteen patients were identified with granulomatous disease who were treated with sulphasalazine between September 2015 and September 2019. Outcomes were based on patients' and providers' subjective evaluations. Sixteen patients were included in the study (ages 56-89, four male and twelve female). Previous treatments were attempted in fifteen patients. Clinical improvement was seen in fourteen patients (87.5%). Initial improvement was noted within a mean (SD) of 66.4 (35.1) days after starting therapy, with increasing benefits over time. Ten patients (62.5%) reported complete or near-complete clearance, three patients (18.8%) reported significant improvement, and one (6.3%) reported partial improvement. Twelve patients elected to stop or reduce therapy, resulting in relapse or worsening in five patients. Sulphasalazine may be considered as treatment for GA and GA-related conditions.

Successful Treatment of Granuloma Annulare with Certolizumab

Generalized granuloma annulare (GA) is a subtype of GA that consists of widespread annular papules and plaques varying in size. There are no randomized trials of treatment for GA, however topical treatment, phototherapy, and various systemic therapies, have been reported to be effective. We report the first case of generalized GA that is successfully treated with certolizumab pegol.

The role of biologics in the treatment of chronic granuloma annulare.

Granuloma annulare (GA), a benign inflammatory skin disease, is considered a Th1-type delayed hypersensitivity reaction. Localized GA is likely to resolve spontaneously, whereas disseminated GA (DGA) may persist for decades and can be resistant to treatment. Biologics including TNF-α inhibitors have been proposed and utilized as salvage therapy for GA and other related diseases, interstitial granulomatous dermatitis (IGD), and actinic granuloma (AG). A systematic review was conducted using the combination of search terms "granuloma annulare," "interstitial granulomatous dermatitis," or "actinic granuloma" and either "biologics," "etanercept," "adalimumab," "infliximab," "ustekinumab," "ixekizumab," "secukinumab," "guselkumab," "golimumab," "brodalumab," "tildrakizumab," or "certolizumab" from the years 1970-2017. Review of the literature revealed that 79.3% of the patients with GA, IGD, or AG who had been treated with demonstrated TNF-α inhibitor therapy a clinical response. TNF-α inhibitor therapy has been used to treat chronic GA, IGD, and AG that involved extensive body surface areas. However, the literature is limited to case series lacking control groups. Randomized, controlled trials are required to establish evidence-based treatment of GA and related cutaneous, granulomatous conditions.

Laser treatment of granuloma annulare: a review

Granuloma annulare (GA) is a benign asymptomatic dermatosis that typically manifests in papules arrayed in annular arrangements. Many methods of treatment have been used with variable degrees of success, but finding a consistent and long-term treatment has proven a challenge. This study was conducted in order to review and evaluate the latest published research on the use of lasers in the treatment of GA. A systematic search of the National Library of Medicine's PubMed database was performed to identify relevant articles. Seven reports met the inclusion criteria for the review. Evidence for the use of pulsed dye laser, fractional photothermolysis, and excimer laser in the treatment of GA was found. Findings are limited by a lack of well-designed clinical trials objectively evaluating the use of lasers in the treatment of GA. The literature review found a number of case reports and case series that report successful outcomes of the use of lasers in the treatment of GA. The promising results reported in the literature, coupled with the lack of a well-designed review on this topic, reflect the importance of this article to the dermatologic literature as it emphasizes the need for larger and better-designed studies on the use of lasers to treat GA.

Treatment of granuloma annulare with the 595‐nm pulsed dye laser, a multicentre retrospective study with long‐term follow‐up

Granuloma annulare (GA) is limited in most cases to isolated lesions, but more widespread generalized forms can be observed. In both cases, the treatment remains highly challenging. Isolated case reports suggested the interest of treating GA with a pulsed dye laser (PDL). To evaluate the PDL in treating GA. Retrospective multicentre study. Each patient should have at least two lesions of GA including at least one that remained untreated to serve as a control. The evaluation was performed on an Investigator Global Assessment for each lesion as compared with baseline. Thirteen patients (five with localized GA and eight with generalized GA) with a total of 59 lesions have been treated with a maximum of three PDL sessions. Sixteen lesions (27.1%) achieved >50% of clearing (14% of lesions for generalized GA and 56.2% for localized GA). Transient hyperpigmentation and crusting were observed in 59% and 86% of lesions respectively. The median follow-up was 6 months (2-12) and 10 lesions (all in generalized GA) recurred after initial clearing. Generalized GA showed weak improvement after treatment with a high recurrence rate. Only localized forms showed notable improvement in a more than half of treated lesions. Thus, PDL could be proposed as an alternative approach, but only for localized forms of GA.

Psoralen and ultraviolet A in the treatment of granuloma annulare

Granuloma annulare (GA) is a benign, usually self-limiting disease. Lesions may be localized or generalized with a tendency for generalized disease to follow a chronic course. There is evidence to support psoralen and ultraviolet A (PUVA) in the treatment of GA, but little data on long-term benefits. The purpose of this study was to investigate the effect of PUVA in the treatment of GA, and to establish clearance and remission rates. We carried out a retrospective study of patients with generalized GA treated with PUVA over 13 years. Data were collected from case notes and a phototherapy database. On completion of treatment, outcome was assessed as clear, good improvement, moderate improvement and poor outcome. Follow-up data were obtained for patients who had cleared using a postal questionnaire in addition to clinic notes. Fifty per cent of courses resulted in clearance of disease, 16% in good improvement, 25% had moderate benefit and 9% had a poor outcome. Of the patients that cleared, 79% remained in remission at 6 months but only 32% were still clear 12 months following treatment. Our findings show clearance or good improvement of generalized GA in 66% of cases. Prolonged remission, however, occurred in less than a third of patients.

Treatment of Granuloma Annulare with the 595 nm Pulsed Dye Laser in a Pediatric Patient

Treatment of Granuloma Annulare with the 595 nm Pulsed Dye Laser in a Pediatric Patient

Treatment of Granuloma Annulare with the 585 nm Pulsed Dye Laser

Granuloma annulare is a chronic asymptomatic dermatosis that is typically manifested by annular papules arising on the dorsa of the hands, feet, elbows, and knees. Multiple treatment modalities have been used with variable efficacy, but no known cure exists. Obtaining long-term resolution of involved areas is often a therapeutic challenge. We report the results of treatment of a patient with localized erythematous granuloma annulare with a 585 nm flashlamp-pumped pulsed dye laser. A single granuloma annulare plaque present on the left wrist for 3 years was treated on three occasions with a 585 nm flashlamp-pumped pulsed dye laser initially and repeated at months 5 and 13. After initial pulsed dye laser treatment, significant flattening and reduction of erythema were evident within the treated area. After a second treatment at month 5 and a third treatment at month 13, further improvement was evident, and long-term remission was achieved. Localized granuloma annulare may be difficult to manage, presenting a therapeutic challenge. Thorough understanding of available treatment options, their relative efficacies, and risks of complication can facilitate successful management of this chronic disease. Pulsed dye laser therapy may be an effective and relatively safe treatment option for erythematous granuloma annulare, although prospective studies in additional patients would be desirable. Improvement of the condition in a single patient does not imply that others might improve, and variability in response is more likely.

Granuloma anulare

Granuloma annulare is a benign self-limiting disease of unknown origin, characterized by dermal papules tending to form annular shapes. It belongs to the granulomatous inflammatory skin diseases characterized by histomorphologically detectable granulomas. In addition to localized variants, generalized or disseminated variants also exist. The disease is often asymptomatic and does not require therapy in every case. Established therapies for localized forms of granuloma annulare are glucocorticosteroids, cream PUVA and cryosurgery. Antimalarials, antileprotics, retinoids, fumarates, UVA1 phototherapy and photochemotherapy are of value in disseminated cases. Recent case reports demonstrate the successful treatment of granuloma annulare with topical calcineurin antagonists or imiquimod and with the systemic administration of biologicals.

Treatment of Granuloma Annulare with the 585 nm Pulsed Dye Laser

Treatment of Granuloma Annulare with the 585 nm Pulsed Dye Laser

Cream psoralen plus ultraviolet A therapy for granuloma annulare.

Treatment modalities for granuloma annulare (GA) often remain unsatisfactory or can be accompanied by potentially hazardous side-effects. Psoralen plus ultraviolet (UV) A (PUVA) bath photochemotherapy has been reported to be highly effective in the treatment of GA. Another form of topical PUVA therapy, using 8-methoxypsoralen-containing cream or gel preparations, has been proven to be as effective as bath PUVA therapy in the treatment of palmoplantar dermatoses. To assess the efficacy of cream PUVA photochemotherapy in patients with GA. Five patients with GA were treated. The diagnosis was confirmed by pretreatment skin biopsies. Cream PUVA therapy was performed four times a week: the mean number of treatments was 26 (range 17-40) and mean cumulative UVA dose was 55.9 J cm-2 (range 18.2-109.2). Cream PUVA photochemotherapy induced significant clinical improvement (one patient) or clearance (four patients) of GA in all patients. Clearance was documented clinically and histopathologically. Cream PUVA phototherapy can be highly effective in patients affected by localized forms of GA.

Treatment of granuloma annulare by local injections with low-dose recombinant human interferon gamma

Treatment of granuloma annulare by local injections with low-dose recombinant human interferon gamma

Treatment of Granuloma Annulare with Tranilast

Three cases of granuloma annulare which did not exhibit a self-limited course were treated with tranilast at the dose of 300 mg/daily. The treatment resulted in the resolution of skin lesions within three months of administration. Although spontaneous resolution is often observed in granuloma annulare, tranilast may provide an alternative therapy for the treatment of cases resistant to spontaneous healing.

Agranulocytosis caused by dapsone therapy for granuloma annulare

Dapsone has been suggested as a useful drug in the treatment of granuloma annulare; however, adverse reactions include a potentially life-threatening agranulocytosis. We report the case of a 50-year-old woman in whom agranulocytosis and septicemia developed after 7 weeks of therapy with dapsone for granuloma annulare. Full recovery followed cessation of this drug, but caution is advised in prescribing dapsone for relatively benign skin conditions.