Apremilast in the Management of Disseminated Granuloma Annulare

Abstract

Granuloma annulare (GA) is a common inflammatory skin condition that manifests as annular skin colored to erythematous papules and plaques. Disseminated GA is a subtype of GA that presents with diffuse cutaneous involvement. While topical and intralesional corticosteroids and phototherapy have been used as therapies for GA, there is no consensus on the best course of treatment for GA. Apremilast is a phosphodiesterase 4 (PDE4) inhibitor that has been Food and Drug Administration (FDA) approved for psoriasis, psoriatic arthritis, and oral ulcers associated with Behcet’s disease; apremilast has also shown promise off-label for other inflammatory skin conditions. Here, we present the case of a woman in whom apremilast use led to an almost complete resolution of her disseminated GA. Our patient tolerated apremilast well and reported no side effects. We also review the literature on the use of apremilast in other patients with GA.

Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options

“…Bishnoi et al then reported a case series of four GA patients treated with apremilast, three of whom experienced a reduction in lesion number and one patient who experienced decreased erythema and pruritus; in all four patients, response to apremilast was seen within 6–8 weeks of initiating treatment [ 70 ]. Joshi and Tschen reported an additional case where apremilast led to near total resolution of lesions in seven months [ 71 ]. Most recently, Hansel et al reported two patients who also experienced marked improvement of their GA within 8 weeks of treatment [ 72 ].…”

Molecularly Targeted Therapies for Inflammatory Cutaneous Granulomatous Disorders: A Review of the Evidence and Implications for Understanding Disease Pathogenesis

“…At the time of our literature review completion, there were nine published reports describing the use of oral apremilast to treat GA. All patients experienced at least partial improvement in a number of lesions, erythema of lesions, and pruritus. Two thirds of these patients had not previously been responsive to topical, systemic, and/or intralesional corticosteroids ( Bishnoi et al., 2019 ; Blum and Altman, 2019 ; Hansel et al., 2021 ; Joshi and Tschen, 2021 ). The exact mechanism of apremilast in GA is not clear but may be related to indirect inhibition of TNF and/or IFN-γ signaling.…”

Evolving utility of apremilast in dermatological disorders for off-label indications

“…Efficacy of apremilast in generalized GA has been documented in several small case series and case reports (Table 9). [41][42][43][44] Larger placebo-controlled trials are required to establish the role of apremilast in generalized GA.…”