Background: Granuloma annulare is a difficult disease to treat and can lead to anxiety and frustration for both patients and providers. The pathogenesis of granuloma annulare is unknown, resulting in few thoroughly studied or consistently effective treatments. Objective: 1) To discuss whether treatment with apremilast could lead to improvement or resolution of generalized granuloma annulare. 2) To explore the possible pathogenesis of granuloma annulare and the mechanism of apremilast in treating this disease. Methods: A case series was used to study the clinical response of 6 patients with a history of recalcitrant generalized granuloma annulare taking apremilast 30mg twice daily. Results: Two patients achieved complete clearance of their disease without recurrence while the remaining 4 patients achieved significant improvement in lesion number, induration, and erythema. Limitations: This is a small case series and larger, controlled trials with long-term follow-up are needed. There is no objective method for evaluating the extent of disease improvement in granuloma annulare. Furthermore, our patients used concomitant topical and intralesional steroids while on apremilast. Conclusion: This case series illustrates a novel therapy, apremilast, a phosphodiesterase-4 inhibitor, in the treatment of patients with generalized granuloma annulare and explores possible mechanisms behind the success of this treatment.

No abstract

As the COVID-19 pandemic continues, the number of patients presenting to dermatology clinics with hair loss is increasing. Little is known about the specifics of telogen effluvium affecting this patient population. We aimed to discover patterns in patient characteristics and clinical course in those with telogen effluvium secondary to COVID-19 infection. We accomplished this by collecting patient history, physical exam, and images on patients presenting to our rural Missouri dermatology clinic with COVID-induced telogen effluvium from July 2020 through March 2021. Of the 19 patients identified, 95% were female, mean age was 56 years, mean onset of hair loss following COVID-19 diagnosis was 2.73 months with a range of 2 weeks to 6 months, and 32% of the patients had been hospitalized from COVID. Furthermore we explore possible pathogenesis behind and special considerations regarding counseling for COVID-induced telogen effluvium. We have concluded that telogen effluvium can occur following both severe and mild COVID-19 infections, may present earlier than TE associated with other causes, and requires unique patient counseling and follow-up given the psychological impact of both COVID-19 and telogen effluvium. Clinicians should be familiar with the unique characteristics of COVID-induced telogen effluvium and how to appropriately manage these patients.

No abstract