Treatment of recalcitrant granuloma annulare (GA) with adalimumab: A single-center, observational study.

Background: Generalized or disseminated granuloma annulare (GA) is therapeutically challenging. Adalimumab, a tumor necrosis factor-α antagonist, has recently been used to treat GA.

Objective: We sought to evaluate adalimumab's efficacy in treating GA.

Methods: We identified 7 patients with physician-verified GA who were treated with adalimumab. Primary endpoints were improvements in GA Investigator Global Assessment score and body surface area. Secondary end points included erythema and induration improvement.

Results: Seven adults, ages 51 to 77 years, were included. All patients' GA Investigator Global Assessment scores improved by 2 or greater. We found significant improvements in body surface area, erythema, and induration (average improvements by 87%, 88%, and 95%, respectively). Two patients required increases in adalimumab frequency. Two others noted GA recurrence; 1 restarted adalimumab and cleared again. Adverse events were minimal.

Limitations: Conclusions are limited because of small sample size and observational nature of the study.

Conclusion: Our results suggest that adalimumab could be an effective and well-tolerated treatment for GA. It is a particularly attractive therapy for patients who have generalized or disseminated GA.