Generalized interstitial granuloma annulare--response to adalimumab.
BACKGROUND
Cause and pathogenesis of granuloma annulare are poorly understood. A foreign-body granuloma formation induced by an unknown inciting antigen is suspected. Generalized forms often coincides with recalcitrant progression and frustrated experimental therapies.


METHODS
We report a case of generalized interstitial granuloma annulare resolving completely after treatment with adalimumab. An initial dose of 80 mg was administered subcutaneously followed by a maintenance dose of 40 mg every two weeks.


RESULTS
Already after two weeks, the eruptions became less infiltrated and paled. After a follow up of 7 weeks, only a residuum of postinflammatory hyperpigmented maculae without infiltration presented. The initially affected body surface area of over 35% reduced to less than 5%. Histopathological examination revealed a significant reduction in the interstitial histiocytic infiltration and the precipitations of mucin.


CONCLUSIONS
Although adalimumab should not be first line therapy for granuloma annulare, our case showed that it may profit well-selected patients and shorten disease duration.
Werchau
Siegfried
S
Department of Dermatology, University of Heidelberg, Heidelberg, Germany. Siegfried.Werchau@med.uni-heidelberg.de
Enk
Alexander
A
Hartmann
Martin
M
D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D005260:Female; D016460:Granuloma Annulare / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D006644:Histiocytes / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab