Treatment of disseminated granuloma annulare recalcitrant to topical therapy: A retrospective 10-year analysis with comparison of photochemotherapy alone versus photochemotherapy plus oral fumaric acid esters

摘要

Granuloma annulare (GA) is a benign inflammatory, often self-limiting disease. In contrast to localized GA with good prognosis and high response rate to topical treatment, disseminated GA tends to follow a chronic course. Topical treatment usually fails. Both phototherapy and systemic drug therapy are used. Oral steroids are commonly used but there are a number of other drugs that have been used in single cases or small series of patients like allopurinol, ciclosporin A, dapsone, methotrexate, tumour necrosis factor-alpha inhibitors or hydroxyurea. In addition to drug therapy or alone phototherapy is an established procedure that has been widely used including narrowband ultraviolet (UV) B, UVA1 or photochemo-therapy with 8-methoxypsoralen (8-MOP) - PUVA. From previous observations we found oral fumaric acid esters (FAE) effective in cases not responding to topical treatment and PUVA. In this study, we analysed patients with disseminated GA during 2001 to 2011 and present our treatment concept of combined photo- and drug therapy with oral fumaric acid esters (FAE).