title: Treatment of disseminated granuloma annulare with oral vitamin E: 'primum nil nocere'.
abstract: BACKGROUND
  Disseminated granuloma annulare (DGA) is a benign and usually asymptomatic skin disease. However, many patients feel aesthetically disfigured and ask for treatment. Until today, no standard therapy is recommended.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of oral vitamin E treatment compared to the natural course of DGA.
  
  
  METHODS
  This single-centre observational cohort study included 38 consecutive patients with histologically confirmed DGA. 21 patients underwent treatment with oral vitamin E, whereas 17 patients preferred a wait-and-see approach.
  
  
  RESULTS
  Complete healing (40%) and improvement (30%) were frequently seen under oral vitamin E therapy. However, DGA also spontaneously disappeared in 31% and improved in 25% of untreated control patients. Vitamin E therapy was very well tolerated.
  
  
  CONCLUSIONS
  Oral vitamin E treatment is a safe and probably effective therapy for DGA. As the natural course of DGA leads to complete healing or significant improvement in many cases, 'primum nil nocere' should be the maxim.
authors.affiliation: Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Poppe
authors.forename: Lidia M
authors.initials: LM
authors.lastname: Poppe
authors.forename: Matthias
authors.initials: M
authors.lastname: Goebeler
authors.forename: Axel
authors.initials: A
authors.lastname: Trautmann
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D016460:Granuloma Annulare / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D014810:Vitamin E / Q000627:therapeutic use*; D014815:Vitamins / Q000627:therapeutic use*; D057832:Watchful Waiting; D055815:Young Adult
chemical_list: D014815:Vitamins; D014810:Vitamin E