Granuloma Annulare Medication

  • Author: Ruby Ghadially, MBChB, FRCP(C)Derm; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 25, 2012
 

Medication Summary

Therapies that may be considered as initial approaches for patients seeking therapy for localized granuloma annulare include intralesional corticosteroids, potent topical corticosteroids alone or under occlusion, and cryotherapy.

Patients with generalized granuloma annulare may accept more aggressive treatment because of the chronicity or pronounced cosmetic disfigurement associated with the disease. Generalized granuloma annulare may be treated initially with isotretinoin or PUVA, if not otherwise contraindicated.

Next

Corticosteroids

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

View full drug information

Clobetasol (ointment, cream, lotion) 0.05% (Temovate, Olux)

 

For inflammatory dermatoses responsive to steroids. Decreases inflammation by suppressing migration of PMN leukocytes and reversing capillary permeability. Affects production of lymphokines and has inhibitory effect on Langerhans cells.

View full drug information

Triamcinolone acetonide (Aristocort, Kenalog)

 

For inflammatory dermatoses responsive to steroids. Decreases inflammation by suppressing migration of PMN leukocytes and reversing capillary permeability. Affects production of lymphokines and has inhibitory effect on Langerhans cells.

View full drug information

Prednisone (Deltasone, Orasone)

 

Synthetic corticosteroid, strong immunosuppressant, and anti-inflammatory drug with proven effects in cutaneous inflammatory disorders.

Previous
Next

Retinoids

Class Summary

Vitamin A derivatives have many roles. They encourage cellular differentiation, are antiproliferative, and serve as immunomodulators.

View full drug information

Isotretinoin (Accutane)

 

Oral agent that treats serious dermatologic conditions. Synthetic 13-cis isomer of the naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A. Should be prescribed only by physicians experienced and/or trained in its use.

A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

Previous
Next

Psoralen phototherapy agents

Class Summary

These agents inhibit cell proliferation.

View full drug information

Methoxsalen plus UVA (8-MOP, Oxsoralen)

 

Inhibits mitosis by binding covalently to pyrimidine bases in DNA when photoactivated by UV-A. May have a direct cytotoxic effect on activated histiocytes, fibroblasts, and lymphocytes in dermal infiltrate of lesions. May control lymphokine production through modulation of activated lymphocytes.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Ruby Ghadially, MBChB, FRCP(C)Derm  Professor, Department of Dermatology, University of California, San Francisco, School of Medicine

Ruby Ghadially, MBChB, FRCP(C)Derm is a member of the following medical societies: American Academy of Dermatology, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Akos Z Szabo, MD  Resident Physician, Department of Obstetrics and Gynecology, University of Heidelberg Medical Center, Germany

Disclosure: Nothing to disclose.

Amit Garg, MD  Director of Clinical Elective in Dermatology, Assistant Professor, Department of Internal Medicine, Division of Dermatology, University of Massachusetts Medical School

Amit Garg, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Student Association/Foundation

Disclosure: Abbott Immunology Honoraria Speaking and teaching; Centocor Grant/research funds Other; RegenRx Grant/research funds Other

Specialty Editor Board

James J Nordlund, MD  Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine

James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

  1. Argent JD, Fairhurst JJ, Clarke NM. Subcutaneous granuloma annulare: four cases and review of the literature. Pediatr Radiol. 1994;24(7):527-9. [Medline].

  2. Felner EI, Steinberg JB, Weinberg AG. Subcutaneous granuloma annulare: a review of 47 cases. Pediatrics. Dec 1997;100(6):965-7. [Medline].

  3. Penas PF, Jones-Caballero M, Fraga J, Sanchez-Perez J, Garcia-Diez A. Perforating granuloma annulare. Int J Dermatol. May 1997;36(5):340-8. [Medline].

  4. Ghadially R. Granuloma annulare, actinic granuloma. In: Arndt K, et al, eds. Cutaneous Medicine and Surgery. WB Saunders Co; 1996:438-443.

  5. Mehta LR, Rose JW. Recurrent granuloma annulare during treatment with daclizumab. Mult Scler. Apr 2009;15(4):527-8. [Medline].

  6. Kakourou T, Psychou F, Voutetakis A, Xaidara A, Stefanaki K, Dacou-Voutetakis C. Low serum insulin values in children with multiple lesions of granuloma annulare: a prospective study. J Eur Acad Dermatol Venereol. Jan 2005;19(1):30-4. [Medline].

  7. Li A, Hogan DJ, Sanusi ID, Smoller BR. Granuloma annulare and malignant neoplasms. Am J Dermatopathol. Apr 2003;25(2):113-6. [Medline].

  8. O'Brien JP, Regan W. Actinically degenerate elastic tissue is the likely antigenic basis of actinic granuloma of the skin and of temporal arteritis. J Am Acad Dermatol. Feb 1999;40(2 Pt 1):214-22. [Medline].

  9. De Maeseneer M, Vande Walle H, Lenchik L, Machiels F, Desprechins B. Subcutaneous granuloma annulare: MR imaging findings. Skeletal Radiol. Apr 1998;27(4):215-7. [Medline].

  10. Shehan JM, El-Azhary RA. Magnetic resonance imaging features of subcutaneous granuloma annulare. Pediatr Dermatol. Jul-Aug 2005;22(4):377-8. [Medline].

  11. Blume-Peytavi U, Zouboulis CC, Jacobi H, Scholz A, Bisson S, Orfanos CE. Successful outcome of cryosurgery in patients with granuloma annulare. Br J Dermatol. Apr 1994;130(4):494-7. [Medline].

  12. Harth W, Linse R. Topical tacrolimus in granuloma annulare and necrobiosis lipoidica. Br J Dermatol. Apr 2004;150(4):792-4. [Medline].

  13. Jain S, Stephens CJ. Successful treatment of disseminated granuloma annulare with topical tacrolimus. Br J Dermatol. May 2004;150(5):1042-3. [Medline].

  14. Rigopoulos D, Prantsidis A, Christofidou E, Ioannides D, Gregoriou S, Katsambas A. Pimecrolimus 1% cream in the treatment of disseminated granuloma annulare. Br J Dermatol. Jun 2005;152(6):1364-5. [Medline].

  15. Kuwahara RT, Naylor MF, Skinner RB. Treatment of granuloma annulare with topical 5% imiquimod cream. Pediatr Dermatol. Jan-Feb 2003;20(1):90. [Medline].

  16. Badavanis G, Monastirli A, Pasmatzi E, Tsambaos D. Successful treatment of granuloma annulare with imiquimod cream 5%: a report of four cases. Acta Derm Venereol. 2005;85(6):547-8. [Medline].

  17. Kerker BJ, Huang CP, Morison WL. Photochemotherapy of generalized granuloma annulare. Arch Dermatol. Mar 1990;126(3):359-61. [Medline].

  18. Looney M, Smith KM. Isotretinoin in the treatment of granuloma annulare. Ann Pharmacother. Mar 2004;38(3):494-7. [Medline].

  19. Passeron T, Fusade T, Vabres P, Bousquet-Rouaud R, Collet-Vilette AM, Dahan S, et al. Treatment of granuloma annulare with the 595-nm pulsed dye laser, a multicentre retrospective study with long-term follow-up. J Eur Acad Dermatol Venereol. Dec 21 2011;[Medline].

  20. Piaserico S, Zattra E, Linder D, Peserico A. Generalized granuloma annulare treated with methylaminolevulinate photodynamic therapy. Dermatology. 2009;218(3):282-4. [Medline].

  21. Weisenseel P, Kuznetsov AV, Molin S, Ruzicka T, Berking C, Prinz JC. Photodynamic therapy for granuloma annulare: more than a shot in the dark. Dermatology. 2008;217(4):329-32. [Medline].

  22. Marcus DV, Mahmoud BH, Hamzavi IH. Granuloma annulare treated with rifampin, ofloxacin, and minocycline combination therapy. Arch Dermatol. Jul 2009;145(7):787-9. [Medline].

  23. Weber HO, Borelli C, Rocken M, Schaller M. Treatment of disseminated granuloma annulare with low-dose fumaric acid. Acta Derm Venereol. 2009;89(3):295-8. [Medline].

  24. Rosmarin D, LaRaia A, Schlauder S, Gottlieb AB. Successful treatment of disseminated granuloma annulare with adalimumab. J Drugs Dermatol. Feb 2009;8(2):169-71. [Medline].

  25. Torres T, Pinto Almeida T, Alves R, Sanches M, Selores M. Treatment of recalcitrant generalized granuloma annulare with adalimumab. J Drugs Dermatol. Dec 2011;10(12):1466-8. [Medline].

  26. [Guideline] Frykberg RG, Zgonis T, Armstrong DG, et al. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg. Sep-Oct 2006;45(5 Suppl):S1-66. [Medline].

  27. Gass JK, Todd PM, Rytina E. Generalized granuloma annulare in a photosensitive distribution resolving with scarring and milia formation. Clin Exp Dermatol. Jul 2009;34(5):e53-5. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.