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.