Granuloma annulare following waxing induced pseudofolliculitis-resolution with isotretinoin

Abstract

We report a case of localized granuloma annulare, successfully treated with isotretinoin, which occurred as a consequence of waxing-induced pseudofolliculitis. To our knowledge this is the first reported clearance of localized granuloma annulare with isotretinoin and the first reported case of granuloma annulare as a sequel to pseudofolliculitis.

Granuloma Annulare

“…Additional reports and small case series have shown improvement in generalized GA with the treatment of oral isotretinoin at doses of 0.5 to 1 mg/kg/d. [131][132][133][134][135]139 In addition to these treatment modalities, there are reports of additional nonimmunosuppressive systemic treatments of generalized GA. These have included calcitriol (0.025 mg daily), 140 niacinamide (1500 mg/d), 141 pentoxifylline (400 mg 3 times daily), 142 potassium iodide, 143 allopurinol (300 mg twice daily), 144 and zileuton (2400 mg daily) combined with vitamin E (400 IU daily).…”

“…Immunosuppression with methotrexate, cyclosporine, and TNF-a inhibitors can be considered in patients with severe disease that has been recalcitrant to other therapies. 28,[87][88][89][90][91][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][114][115][116][117][118][119][120][121][122][123][124]126,127,129,130,[132][133][134][140][141][142][144][145][146][147][148]150,…”

Isotretinoin in the Treatment of Granuloma Annulare

“…LGA responsive to isotretinoin GA was noted in a 2000 case report. 20 A 36-year-old woman with LGA resulting from waxing-induced pseudofolliculitis was refractory to 50 cycles of PUVA, oxypentifylline, and nicotinamide. A trial of isotretinoin 40 mg (0.5 mg/kg) daily for 2 months led to considerable lesion flattening.…”

Isotretinoin – unapproved indications/uses and dosage: a physician's reference

“…Ever since its approval in 1982 for use in severe acne by the United States’ Food and Drug Administration (FDA), it has been used extensively worldwide 1–3 . Over the years the drug has proved to be useful in multifarious chronic, progressive, recalcitrant dermatological disorders other than acne 4–12 . Although technically “off‐label” uses these reports have rekindled hope for the therapy of such skin disorders, which have no other tenable therapeutic solution.…”

“…1-3 Over the years the drug has proved to be useful in multifarious chronic, progressive, recalcitrant dermatological disorders other than acne. [4][5][6][7][8][9][10][11][12] Although technically "off-label" uses these reports have rekindled hope for the therapy of such skin disorders, which have no other tenable therapeutic solution. The present appraisal attempts to highlight these "off-label" uses of isotretinoin, which after further research may form a significant component in the therapeutic armamentarium of these hitherto therapeutically frustrating disorders.…”