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Journal of the American Academy of Dermatology
Volume 74, n° 1
pages 127-133 (janvier 2016)
Doi : 10.1016/j.jaad.2015.09.015
accepted : 9 September 2015
Original Articles

Treatment of recalcitrant granuloma annulare (GA) with adalimumab: A single-center, observational study

Michelle S. Min, MSci a, b, Mark Lebwohl, MD a,
a Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York 
b Boston University School of Medicine, Boston, Massachusetts 

Correspondence to: Mark Lebwohl, MD, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 E 98 St, Fifth Floor, New York, NY 10029.

Generalized or disseminated granuloma annulare (GA) is therapeutically challenging. Adalimumab, a tumor necrosis factor-α antagonist, has recently been used to treat GA.


We sought to evaluate adalimumab's efficacy in treating GA.


We identified 7 patients with physician-verified GA who were treated with adalimumab. Primary endpoints were improvements in GA Investigator Global Assessment score and body surface area. Secondary end points included erythema and induration improvement.


Seven adults, ages 51 to 77 years, were included. All patients' GA Investigator Global Assessment scores improved by 2 or greater. We found significant improvements in body surface area, erythema, and induration (average improvements by 87%, 88%, and 95%, respectively). Two patients required increases in adalimumab frequency. Two others noted GA recurrence; 1 restarted adalimumab and cleared again. Adverse events were minimal.


Conclusions are limited because of small sample size and observational nature of the study.


Our results suggest that adalimumab could be an effective and well-tolerated treatment for GA. It is a particularly attractive therapy for patients who have generalized or disseminated GA.

The full text of this article is available in PDF format.

Key words : adalimumab, etanercept, granuloma annulare, infliximab, Investigator Global Assessment, treatment, tumor necrosis factor-α inhibitor

Abbreviations used : BSA, GA, IGA, IL, TNF

 Funding sources: None.
 Disclosure: Dr Lebwohl is an employee of the Mount Sinai Medical Center which receives research funds from AbGenomics, AbbVie, Amgen, Anacor, Aqua, Canfite Biopharma, Celgene, Clinuvel, Coronado Biosciences, Ferndale, Lilly, Janssen Biotech, LEO Pharmaceuticals, Merz, Novartis, Pfizer, Sandoz, Sun Pharmaceuticals, and Valeant. Ms Min has no conflicts of interest to declare.
 Reprints not available from the authors.

© 2015  American Academy of Dermatology, Inc.@@#104156@@