title: Treatment of recalcitrant granuloma annulare (GA) with adalimumab: A single-center, observational study.
abstract: BACKGROUND
  Generalized or disseminated granuloma annulare (GA) is therapeutically challenging. Adalimumab, a tumor necrosis factor-α antagonist, has recently been used to treat GA.
  
  
  OBJECTIVE
  We sought to evaluate adalimumab's efficacy in treating GA.
  
  
  METHODS
  We identified 7 patients with physician-verified GA who were treated with adalimumab. Primary endpoints were improvements in GA Investigator Global Assessment score and body surface area. Secondary end points included erythema and induration improvement.
  
  
  RESULTS
  Seven adults, ages 51 to 77 years, were included. All patients' GA Investigator Global Assessment scores improved by 2 or greater. We found significant improvements in body surface area, erythema, and induration (average improvements by 87%, 88%, and 95%, respectively). Two patients required increases in adalimumab frequency. Two others noted GA recurrence; 1 restarted adalimumab and cleared again. Adverse events were minimal.
  
  
  CONCLUSIONS
  Conclusions are limited because of small sample size and observational nature of the study.
  
  
  CONCLUSIONS
  Our results suggest that adalimumab could be an effective and well-tolerated treatment for GA. It is a particularly attractive therapy for patients who have generalized or disseminated GA.
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Min
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: lebwohl@aol.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Lebwohl
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D016460:Granuloma Annulare / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage / Q000037:antagonists & inhibitors*
chemical_list: D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab
keywords: Investigator Global Assessment; adalimumab; etanercept; granuloma annulare; infliximab; treatment; tumor necrosis factor-α inhibitor