Treatment of generalized granuloma annulare with apremilast: A report of 2 cases

Blum, Stacy; Altman, David A.

doi:10.1016/j.jdcr.2019.09.015

Cited by 16 publications

(18 citation statements)

References 10 publications

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“…Although spontaneous improvement of GA in our patient cannot be completely excluded, the temporal clinical and symptomatic improvement makes it likely that the patient’s remission is putatively due to apremilast treatment. The minor flare-up observed at seven-month follow-up is similar to what is reported in the literature in other patients who experienced improvement without complete resolution [ 9 , 10 ]. Furthermore, we note that while spontaneous remission for localized GA is common, the more generalized form of the disease, which was present in our patient, can persist for years [ 11 ].…”

Section: Discussionsupporting

confidence: 87%

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Apremilast in the Management of Disseminated Granuloma Annulare

Joshi¹,

Tschen²

2021

Cureus

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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.

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Section: Discussionsupporting

confidence: 87%

“…One patient experienced partial resolution of their lesions and the other patient experienced an improvement in erythema and lesion induration. Both patients tolerated apremilast well [ 9 ]. Bishnoi et al reported apremilast to be effective in the treatment of recalcitrant GA in four additional patients.…”

Section: Discussionmentioning

confidence: 99%

Apremilast in the Management of Disseminated Granuloma Annulare

Joshi¹,

Tschen²

2021

Cureus

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“…Apremilast is a phosphodiesterase-4 inhibitor that has been licensed for the treatment of psoriasis, psoriatic arthritis, and oral ulcers associated with Behcet’s disease [ 68 ]. Several recent case reports recommend further investigation of apremilast in the management of GA. Blum and Altman reported the first two cases of GA treated with apremilast: one patient experienced durable improvement in erythema and induration of lesions in 3 months and the other patient had near complete remission of lesions at 4 months [ 69 ]. 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 ].…”

Section: Review Of Management Optionsmentioning

confidence: 99%

“…The excellent response of GA to anti-TNFα therapy seen in several patients [ 51 , 73 – 75 ] supports recent studies that implicate overactivation of the Th1 pathway in GA [ 35 , 36 ]. Recent cases demonstrating response of GA to apremilast [ 69 – 72 ] further indite Th1 axis dysregulation in GA, as apremilast also downregulates TNFα expression. The response of GA to dupilumab, as reported by Song et al [ 76 ] suggests that the Th2 pathway may also be hyperactive in GA, supporting the study by Min et al, which found a marked increase in IL-4 mRNA expression in GA lesional skin compared with non-lesional skin [ 35 ].…”

Section: Does Treatment Recapitulate Pathogenesis?mentioning

confidence: 99%

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

Joshi

Duvic

2021

Am J Clin Dermatol

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Granuloma annulare (GA) is an inflammatory granulomatous skin disease that can be localized (localized GA) or disseminated (generalized GA), with patch, perforating, and subcutaneous subtypes being less common variants of this benign condition. Recently, new research has emerged that further elucidates GA epidemiology and etiopathogenesis; importantly, new therapeutic options for GA have also been described, although there remains a paucity of randomized controlled studies. In this review, we summarize recent updates on GA epidemiology and etiopathogenesis and offer an updated review of the therapeutic options for GA currently reported in the literature. We hope that the current review galvanizes randomized controlled studies that will in turn help lead to the recommendation of evidence-based treatments for GA.

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“…Apremilast is approved to treat plaque psoriasis, psoriatic arthritis, and oral ulcers for Behcet disease and has also been used off-label for lichen planus, hidradenitis suppurativa, pityriasis rubra pilaris, and generalized granuloma annulare. 6 , 7 , 8 , 9 This is the first reported case of its successful use for EAC. Apremilast inhibits phosphodiesterase 4, thereby increasing the concentration of cyclic-adenosine-monophosphate, altering the gene expression of lymphocytes and macrophages.…”

Section: Discussionmentioning

confidence: 80%