Article: Successful Treatment of Disseminated Granuloma Annulare with Upadacitinib

Disseminated granuloma annulare (DGA) is an inflammatory skin disorder characterized by more than 10 erythematous, raised, ring-shaped plaques. Its treatment remains challenging, with conventional therapies showing variable efficacy. We report the case of a woman in her 50s with a 2-year history of DGA refractory to multiple treatments. Given the recent evidence of the role of the Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway in the granuloma annulare pathophysiology, treatment with upadacitinib 30 mg per day was started with rapid effectiveness and good tolerance. This case underscores the potential of JAK inhibitors as promising therapeutic options for recalcitrant granuloma annulare.

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References

1.

Thornsberry L, English 3rd J . Etiology, diagnosis, and therapeutic management of granuloma annulare: an update. Am J Clin Dermatol. 2013; 14(4):279-90. DOI: 10.1007/s40257-013-0029-5. View

2.

Fornons-Servent R, Bauer-Alonso A, Llobera-Ris C, Penin R, Marcoval J . Granuloma Annulare: a Case-control Study of Possible Associated Diseases. Dermatol Pract Concept. 2022; 12(4):e2022173. PMC: 9681221. DOI: 10.5826/dpc.1204a173. View

3.

Rankin B, Haber R . Familial granuloma annulare: First report of occurrence in a father and daughter and updated review of the literature. JAAD Case Rep. 2021; 17:61-64. PMC: 8523978. DOI: 10.1016/j.jdcr.2021.09.023. View

4.

Lukacs J, Schliemann S, Elsner P . Treatment of generalized granuloma annulare - a systematic review. J Eur Acad Dermatol Venereol. 2015; 29(8):1467-80. DOI: 10.1111/jdv.12976. View

5.

Dopytalska K, Gabzdyl N, Szczerba M, Szymanska E, Walecka I . Is biologic therapy the future of granuloma annulare treatment?. Dermatol Ther. 2021; 35(1):e15188. DOI: 10.1111/dth.15188. View

6.

Min M, Wu J, He H, Sanz-Cabanillas J, Del Duca E, Zhang N . Granuloma annulare skin profile shows activation of T-helper cell type 1, T-helper cell type 2, and Janus kinase pathways. J Am Acad Dermatol. 2019; 83(1):63-70. DOI: 10.1016/j.jaad.2019.12.028. View

7.

OReilly S, Ciechomska M, Cant R, Hugle T, van Laar J . Interleukin-6, its role in fibrosing conditions. Cytokine Growth Factor Rev. 2012; 23(3):99-107. DOI: 10.1016/j.cytogfr.2012.04.003. View

8.

Kim D, Kang H . Rapid improvement of refractory generalized granuloma annulare with the Janus kinase inhibitor baricitinib in two patients. Clin Exp Dermatol. 2023; 48(4):375-376. DOI: 10.1093/ced/llac110. View

9.

Ballova A, Kmecova Z, Pec J, Vorcakova K . Recalcitrant granuloma annulare induced by two different biologic agents resolved after Janus kinase inhibitor treatment. Dermatol Ther. 2022; 35(8):e15641. DOI: 10.1111/dth.15641. View

10.

Slater K, Valk B, Kartono F . A case of generalized granuloma annulare treated with upadacitinib. JAAD Case Rep. 2023; 34:12-14. PMC: 10015114. DOI: 10.1016/j.jdcr.2023.01.027. View

11.

Sondermann W, Hadaschik E, Specker C . Successful therapy of disseminated patch-type granuloma annulare with upadacitinib in a patient with rheumatoid arthritis. Dermatol Ther. 2021; 35(1):e15211. DOI: 10.1111/dth.15211. View