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.

Treatment of generalized granuloma annulare – a systematic review

“…Vitamin E therapy was reported to be an effective treatment of GGA . Vitamin E decreases the secretion of IL‐1β in monocytes .…”

“…Vitamin E therapy was reported to be an effective treatment of GGA . Vitamin E decreases the secretion of IL‐1β in monocytes . Topical Vitamin E could be effective due to its potential as antioxidant and as scavenger of free oxygen radicals, which may play an essential role in the pathogenesis of GA and tissue damage .…”

“…61 Vitamin E decreases the secretion of IL-1b in monocytes. 61,62 Topical Vitamin E could be effective due to its potential as antioxidant and as scavenger of free oxygen radicals, which may play an essential role in the pathogenesis of GA and tissue damage. 5,[63][64][65] Vitamin E treatment seems to be a safe therapy, no side-effects were reported so far.…”

Dietary combination of vitamin E, C and K affects growth, antioxidant activity, and the incidence of systemic granulomatosis in meagre (Argyrosomus regius)

“…Vitamin E and C can modulate inflammatory reactions related to nuclear factor kappaB (Han et al, 2004;Poppe et al, 2013), which is responsible of the up-regulation of inflammatory cytokines, such as tumor necrosis factor (tnfα) and cyclooxygenase (cox-2) (Fox et al, 1997). TNFα is a crucial regulator and effector in the process of mounting innate and adaptive immune responses, regulating cell death and survival (Locksley et al, 2001), while COX-2 is a prostaglandin synthesis enzyme that plays a key role in inflammation in fish (Ishikawa et al, 2007ab) and is responsible for conversion of arachidonic acid into prostaglandin, related to the fish innate immune response (Xu et al, 2008;Legler et al, 2010).…”

11 «De trenger henne mer enn jeg gjør»

“…Ansvar og medfølelse, skyld og forsoning, er temaer som går igjen i Erik Poppes filmer, saerlig i den såkalte Oslo-trilogien (Schpaaa [1998], Hawaii, Oslo [2004, og deUSYNLIGE [2008]). Ifølge Elisabeth Oxfeldt (2010) preges Oslo-trilogien av kristen symbolikk og ideologi, og utforsker tema som menneskelig godhet, kjaerlighet og medfølelse (s. 64-65).…”