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Treatment of disseminated granuloma annulare with fumaric acid esters.

Kreuter A, Gambichler T, Altmeyer P, Brockmeyer NH - BMC Dermatol. (2002)

Bottom Line: With the exception of temporary lymphopenia, no adverse effects were observed.The patient remained in remission during a six-month follow up period.Our observation has demonstrated that FAE is a potentially beneficial therapeutic option for patients with recalcitrant DGA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany. a.kreuter@derma.de

ABSTRACT

Background: Granuloma annulare is a granulomatous disease of unknown etiology. Various therapies have been tried in disseminated granuloma annulare (DGA), including corticosteroids, several variants of psoralen plus ultraviolet-A radiation, ultraviolet- A1 radiation, systemic retinoids, and dapsone, with variable success. We report a patient with recalcitrant DGA who was treated with fumaric acid esters (FAE).

Case presentation: A 40-year old Caucasian woman presented with a 25-year history of recalcitrant DGA. On both legs and the abdomen there were erythematous annular plaques. She was treated with FAE in tablet form using two formulations differing in strength (low strength tablets: 30 mg dimethylfumarate, 67 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt; high strength tablets: 120 mg dimethylfumarate, 87 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt). After three-month therapy, an almost complete clearance of skin lesions was achieved. With the exception of temporary lymphopenia, no adverse effects were observed. The patient remained in remission during a six-month follow up period.

Conclusions: Our observation has demonstrated that FAE is a potentially beneficial therapeutic option for patients with recalcitrant DGA. However controlled trials are necessary to fully explore the efficacy, optimal dosage, and safety of FAE in the management of DGA.

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Related in: MedlinePlus

Long-standing disseminated granuloma annulare on the left leg.
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Figure 1: Long-standing disseminated granuloma annulare on the left leg.

Mentions: A 40-year old Caucasian woman presented with a 25-year history of DGA on both legs. Since one year, she also had lesions on the abdomen. Previous treatments with various therapeutic modalities (e.g., corticosteroids, dapsone, and bath psoralen plus ultraviolet-A radiation) were ineffective. On examination, she had erythematous annular plaques on the abdomen and on both legs (Fig. 1). Histopathologic examination of a punch biopsy specimen from the left leg revealed a normal epidermis. Below the epidermis there was mild collagen degeneration surrounded by palisading inflammatory cells. The infiltrates consisted of a mixture of monocytes, histiocytes, and occasional giant cells. These findings were consistent with the diagnosis of DGA. Complete work-up did not reveal evidence of malignancies, infections, and internal diseases such as diabetes mellitus.


Treatment of disseminated granuloma annulare with fumaric acid esters.

Kreuter A, Gambichler T, Altmeyer P, Brockmeyer NH - BMC Dermatol. (2002)

Long-standing disseminated granuloma annulare on the left leg.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC101386&req=5

Figure 1: Long-standing disseminated granuloma annulare on the left leg.
Mentions: A 40-year old Caucasian woman presented with a 25-year history of DGA on both legs. Since one year, she also had lesions on the abdomen. Previous treatments with various therapeutic modalities (e.g., corticosteroids, dapsone, and bath psoralen plus ultraviolet-A radiation) were ineffective. On examination, she had erythematous annular plaques on the abdomen and on both legs (Fig. 1). Histopathologic examination of a punch biopsy specimen from the left leg revealed a normal epidermis. Below the epidermis there was mild collagen degeneration surrounded by palisading inflammatory cells. The infiltrates consisted of a mixture of monocytes, histiocytes, and occasional giant cells. These findings were consistent with the diagnosis of DGA. Complete work-up did not reveal evidence of malignancies, infections, and internal diseases such as diabetes mellitus.

Bottom Line: With the exception of temporary lymphopenia, no adverse effects were observed.The patient remained in remission during a six-month follow up period.Our observation has demonstrated that FAE is a potentially beneficial therapeutic option for patients with recalcitrant DGA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany. a.kreuter@derma.de

ABSTRACT

Background: Granuloma annulare is a granulomatous disease of unknown etiology. Various therapies have been tried in disseminated granuloma annulare (DGA), including corticosteroids, several variants of psoralen plus ultraviolet-A radiation, ultraviolet- A1 radiation, systemic retinoids, and dapsone, with variable success. We report a patient with recalcitrant DGA who was treated with fumaric acid esters (FAE).

Case presentation: A 40-year old Caucasian woman presented with a 25-year history of recalcitrant DGA. On both legs and the abdomen there were erythematous annular plaques. She was treated with FAE in tablet form using two formulations differing in strength (low strength tablets: 30 mg dimethylfumarate, 67 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt; high strength tablets: 120 mg dimethylfumarate, 87 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt). After three-month therapy, an almost complete clearance of skin lesions was achieved. With the exception of temporary lymphopenia, no adverse effects were observed. The patient remained in remission during a six-month follow up period.

Conclusions: Our observation has demonstrated that FAE is a potentially beneficial therapeutic option for patients with recalcitrant DGA. However controlled trials are necessary to fully explore the efficacy, optimal dosage, and safety of FAE in the management of DGA.

Show MeSH
Related in: MedlinePlus