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Michels A, Heiland R, Hammerschmidt S, Farcas A, Voigt TP, Braun SA, Metze D, Tsianakas A. Erfolgreiche Behandlung eines therapieresistenten generalisierten Granuloma anulare mit dem JAK‐Inhibitor Abrocitinib. J Dtsch Dermatol Ges 2024; 22:841-843. [PMID: 38857107 DOI: 10.1111/ddg.15426_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 01/11/2024] [Indexed: 06/11/2024]
Affiliation(s)
| | - Rebecca Heiland
- Klinik für Dermatologie und Allergologie, Fachklinik Bad Bentheim
| | | | - Alexandra Farcas
- Klinik für Dermatologie und Allergologie, Fachklinik Bad Bentheim
| | | | | | - Dieter Metze
- Klinik für Hautkrankheiten, Universitätsklinikum Münster
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Michels A, Heiland R, Hammerschmidt S, Farcas A, Voigt TP, Braun SA, Metze D, Tsianakas A. Successful treatment of recalcitrant generalized granuloma annulare with the JAK inhibitor abrocitinib. J Dtsch Dermatol Ges 2024; 22:841-843. [PMID: 38491389 DOI: 10.1111/ddg.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 01/11/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Alexander Michels
- Department of Dermatology and Allergology, Specialist Hospital Bad Bentheim, Bad Bentheim, Germany
| | - Rebecca Heiland
- Department of Dermatology and Allergology, Specialist Hospital Bad Bentheim, Bad Bentheim, Germany
| | - Stephanie Hammerschmidt
- Department of Dermatology and Allergology, Specialist Hospital Bad Bentheim, Bad Bentheim, Germany
| | - Alexandra Farcas
- Department of Dermatology and Allergology, Specialist Hospital Bad Bentheim, Bad Bentheim, Germany
| | - Tilman Peter Voigt
- Department of Dermatology and Allergology, Specialist Hospital Bad Bentheim, Bad Bentheim, Germany
| | | | - Dieter Metze
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Athanasios Tsianakas
- Department of Dermatology and Allergology, Specialist Hospital Bad Bentheim, Bad Bentheim, Germany
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Hwang E, Abdelghaffar M, Shields BE, Damsky W. Molecularly Targeted Therapies for Inflammatory Cutaneous Granulomatous Disorders: A Review of the Evidence and Implications for Understanding Disease Pathogenesis. JID INNOVATIONS 2023; 3:100220. [PMID: 37719661 PMCID: PMC10500476 DOI: 10.1016/j.xjidi.2023.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 09/19/2023] Open
Abstract
Inflammatory cutaneous granulomatous diseases, including granuloma annulare, cutaneous sarcoidosis, and necrobiosis lipoidica, are distinct diseases unified by the hallmark of macrophage accumulation and activation in the skin. There are currently no Food and Drug Administration-approved therapies for these conditions except prednisone and repository corticotropin injection for pulmonary sarcoidosis. Treatment of these diseases has generally been guided by low-quality evidence and may involve broadly immunomodulatory medications. Development of new treatments has in part been limited by an incomplete understanding of disease pathogenesis. Recently, there has been substantial progress in better understanding the molecular pathogenesis of these disorders, opening the door for therapeutic innovation. Likewise, reported outcomes of treatment with immunologically targeted therapies may offer insights into disease pathogenesis. In this systematic review, we summarize progress in deciphering the pathomechanisms of these disorders and discuss this in the context of emerging evidence on the use of molecularly targeted therapies in treatment of these diseases.
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Affiliation(s)
- Erica Hwang
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mariam Abdelghaffar
- School of Medicine, Royal College of Surgeons in Ireland, Busaiteen, Bahrain
| | - Bridget E. Shields
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
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Treatment of Generalized Granuloma Annulare with Oral Griseofulvin. Case Rep Dermatol Med 2022; 2022:2523710. [DOI: 10.1155/2022/2523710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background. Granuloma annulare (GA) is a benign skin disease that has four clinical variants including localized, generalized, perforating, and subcutaneous GA. The most common type is localized GA, followed by generalized GA. Generalized GA was defined as at least 10 widespread annular plagues and frequently on the trunk, face, neck, and extremities. The diagnosis was made by clinical and histopathology. Generalized GA was difficult to treat. Case Presentation. We presented a Thai woman with nonscaly annular papules and plaques on the trunk and all extremities. A skin biopsy revealed a lesion that was compatible with granuloma annulare. She was partially resolved with 2-month course of oral griseofluvin 500 mg daily. Discussion. The regression of GA response to oral griseofulvin is consistent with the inflammatory nature, which identified IFN-gamma upregulated in GA. Conclusion. Griseofulvin is safe with few side effects and cost effectiveness. Further studies are needed to better understand the immunology and pathogenesis of GA.
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Bosch-Amate X, Serra-García L, Alamon-Reig F, Marti-Marti I, Gil-Lianes J, Giavedoni P, Mascaró JM. Treatment of granuloma annulare with tofacitinib. Australas J Dermatol 2022; 63:400-403. [PMID: 35605155 PMCID: PMC9541638 DOI: 10.1111/ajd.13875] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Xavier Bosch-Amate
- Department of Dermatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Laura Serra-García
- Department of Dermatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Francesc Alamon-Reig
- Department of Dermatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ignasi Marti-Marti
- Department of Dermatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Javier Gil-Lianes
- Department of Dermatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Priscila Giavedoni
- Department of Dermatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - José M Mascaró
- Department of Dermatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options. Am J Clin Dermatol 2022; 23:37-50. [PMID: 34495491 PMCID: PMC8423598 DOI: 10.1007/s40257-021-00636-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 12/20/2022]
Abstract
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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Janßen S, Jansen TM. Ulcerated necrobiosis lipoidica successfully treated with tofacitinib. Int J Dermatol 2021; 61:739-741. [PMID: 34783006 DOI: 10.1111/ijd.15960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/12/2021] [Accepted: 10/14/2021] [Indexed: 01/04/2023]
Affiliation(s)
- Sarah Janßen
- Institute of Dermatology, Heinrich-Heine University and University Hospital of Duesseldorf, Düsseldorf, Germany
| | - Theresa M Jansen
- Institute of Dermatology, Heinrich-Heine University and University Hospital of Duesseldorf, Düsseldorf, Germany
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McPhie ML, Swales WC, Gooderham MJ. Improvement of granulomatous skin conditions with tofacitinib in three patients: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211039477. [PMID: 34422275 PMCID: PMC8375329 DOI: 10.1177/2050313x211039477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Granulomatous skin conditions are poorly understood inflammatory skin diseases consisting predominantly of macrophages. Granuloma annulare (GA) is the most common granulomatous skin disease and the generalized variant is particularly difficult to treat due to the prolonged course and lack of efficacious treatment options. Necrobiosis lipoidica (NL) is another granulomatous disorder of uncertain etiology. There is a growing body of evidence for the use of Janus kinase (JAK) inhibitors in the management of inflammatory skin diseases. In our report, we describe three patients with recalcitrant granulomatous disease including NL and generalized GA who responded favourably to treatment with the JAK inhibitor tofacitinib. JAK inhibitors may be a beneficial therapeutic option for patients with granulomatous skin diseases that are unresponsive to conventional therapies. Further research is required to determine the long-term efficacy and safety of JAK inhibitors in treating granulomatous skin conditions.
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Affiliation(s)
| | - William C Swales
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | - Melinda J Gooderham
- Queen’s University, Kingston, ON, Canada
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
- Melinda J Gooderham, SKiN Centre for Dermatology, 775 Monaghan Road, Peterborough, ON K9J 5K2, Canada.
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Alam M, Fang V, Rosenbach M. Treatment of cutaneous sarcoidosis with tofacitinib 2% ointment and extra virgin olive oil. JAAD Case Rep 2021; 9:1-3. [PMID: 33598514 PMCID: PMC7868739 DOI: 10.1016/j.jdcr.2020.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Mariam Alam
- Department of Internal Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Victoria Fang
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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