title: Granuloma annulare treated with rifampin, ofloxacin, and minocycline combination therapy.
abstract: BACKGROUND
  Granuloma annulare (GA) is a benign, usually self-limiting, dermatosis, that typically presents as asymptomatic, flesh-colored or erythematous papules, frequently arranged in an annular or arciform pattern on the distal extremities. Although localized GA is most commonly observed, a generalized or disseminated form can occur. The etiology of GA is unknown; however, multiple inciting factors have been proposed. Histologically, GA is characterized by foci of degenerative collagen associated with palisading, sometimes infiltrating granulomatous inflammation.
  
  
  METHODS
  We report 6 cases with biopsy-proved GA, resistant to the standard modalities of treatment that resolved after 3 months with monthly rifampin (600 mg), ofloxacin (400 mg), and minocycline hydrochloride (100 mg) combination therapy. Rifampin, ofloxacin, and minocycline combination therapy has been successfully used to treat patients with paucibacillary leprosy. Given reports that prolonged antibiotic agents are a useful treatment for GA, rifampin (600 mg), ofloxacin (400 mg), and minocycline hydrochloride (100 mg) combination therapy was initiated in these patients. Complete clearance of the plaques was achieved 3 to 5 months after the initiation of treatment. Some patients experienced postinflammatory hyperpigmentation.
  
  
  CONCLUSIONS
  Although our treatment was effective, further studies may be needed to confirm the success of this therapeutic option for patients with recalcitrant lesions of GA.
authors.affiliation: Department of Dermatology, Henry Ford Hospital, Detroit, MI 48202, USA.
authors.forename: Dione V
authors.initials: DV
authors.lastname: Marcus
authors.forename: Bassel H
authors.initials: BH
authors.lastname: Mahmoud
authors.forename: Iltefat H
authors.initials: IH
authors.lastname: Hamzavi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D016460:Granuloma Annulare / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage*; D015242:Ofloxacin / Q000008:administration & dosage*; D012293:Rifampin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D015242:Ofloxacin; D008911:Minocycline; D012293:Rifampin