Granuloma Annulare Medication

Updated: Oct 29, 2018
  • Author: Ruby Ghadially, MBChB, FRCP(C)Derm; Chief Editor: William D James, MD  more...
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Medication

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, antimalarials, or PUVA, if not otherwise contraindicated.

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Corticosteroids

Class Summary

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

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

Clobetasol is used for inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing the migration of PMN leukocytes and reversing capillary permeability. Clobetasol affects the production of lymphokines and has inhibitory effects on Langerhans cells.

Triamcinolone topical (Kenalog Orabase, Kenalog topical, Pediaderm TA)

Triamcinolone is used for inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing the migration of PMN leukocytes and reversing capillary permeability. Triamcinolone affects production of lymphokines and has inhibitory effects on Langerhans cells.

Prednisone (Deltasone, Orasone)

Prednisone is a synthetic corticosteroid, strong immunosuppressant, and anti-inflammatory drug with proven effects in cutaneous inflammatory disorders.

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Retinoids

Class Summary

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

Isotretinoin (Accutane)

Isotretinoin is an oral agent that treats serious dermatologic conditions. It is a synthetic 13-cis isomer of the naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A. Isotretinoin 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.

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Psoralen phototherapy agents

Class Summary

These agents inhibit cell proliferation.

Methoxsalen plus UVA (8-MOP, Oxsoralen)

Methoxsalen plus UVA inhibits mitosis by binding covalently to pyrimidine bases in DNA when photoactivated by UVA. It may have a direct cytotoxic effect on activated histiocytes, fibroblasts, and lymphocytes in the dermal infiltrate of lesions. Methoxsalen plus UVA may control lymphokine production through modulation of activated lymphocytes.

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