We thank Kreuter and colleagues for their letter and review of their own experiences. The varying responses of different patients support a role for tumor necrosis factor in GA. Perhaps this situation may be similar to multiple sclerosis, in which immunomodulators may help a patient with the disease but induce symptoms of demyelination in people who do not have the disease. Until additional patients with GA are treated with etanercept, no definitive conclusion can be reached.
Shupack JL, Siu K. Failure of Etanercept Therapy in Disseminated Granuloma Annulare—Reply. Arch Dermatol. 2006;142(9):1231-1244. doi:10.1001/archderm.142.9.1237-a