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Granuloma annulare (GA) is a condition of unknown cause characterized by the appearance of cutaneous necrobiotic granuloma. Localized forms of GA are usually asymptomatic and self-limited, with spontaneous resolution occurring often within 2 years. However, disseminated GA (DGA) tends to be more chronic and pruritic and may last for decades.
Some investigations have shown that an overexpression of tumor necrosis factor α (TNF-α) by peripheral mononuclear lymphocytes and macrophages may play a role in the development of GA.1 Tumor necrosis factor α blocking agents such as etanercept and infliximab have helped resolve the disease in some cases.2,3 In others, however, no response or a worsening of the condition was reported.4 The reason for this varying response remains unknown.
Knoell KA. Efficacy of Adalimumab in the Treatment of Generalized Granuloma Annulare in Monozygotic Twins Carrying the 8.1 Ancestral Haplotype. Arch Dermatol. 2009;145(5):610-611. doi:10.1001/archdermatol.2009.92