Recalcitrant generalized granuloma annulare treated successf
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A 74-year-old woman with a past medical history of hypertension, hyperlipidemia and depression presented with a 2-year history of dark red annular dermal plaques with clearly distinguishable thickening involving the arms, chest, abdomen and legs. Histopathology was consistent with granuloma annulare.

She had previously failed treatment with ultrapotent topical steroids, oral antibiotics (rifampin, ofloxacin and minocycline), hydroxychloroquine, methotrexate, niacinamide, allopurinol and adalimumab. Based on the results of a preclinical study showing that Th2 signaling may play a role in granuloma annulare, patient agreed to off-label treatment with dupilumab.

Standard biologic screening was done which included a complete blood count, comprehensive metabolic panel, quantiferon gold, hepatitis B panel, hepatitis C antibody. A loading dose of dupilumab 600mg was administered SC at weeks 0 and then decreased to 300mg every two weeks thereafter. At her 4 week follow up, patient had complete clearance of her abdomen, distal shins and dorsal feet. She still had some residual annular dermal plaques on her arms and thighs but the erythema and induration had significantly improved. At her 12-week follow up, patient remained clear except for her proximal arms and thighs. Patient overall was very satisfied with her improvement and stated that her skin had no to minimal impact on her quality-of-life.

Source: https://www.jaadcasereports.org/article/S2352-5126(20)30759-1/fulltext?rss=yes
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