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Correspondence |

Efficacy of Adalimumab in the Treatment of Generalized Granuloma Annulare in Monozygotic Twins Carrying the 8.1 Ancestral Haplotype

Keith Allen Knoell, MD
Arch Dermatol. 2009;145(5):610-611. doi:10.1001/archdermatol.2009.92.
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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.

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Figure 1.

Figure 1. Generalized granuloma annulare on the abdomen before (A) and after (B) treatment with adalimumab, 40 mg/wk for 12 weeks.

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Figure 2.

Figure 2. Lymphocytic perivascular infiltrate and an interstitial infiltrate composed of epithelioid macrophages surrounding foci of necrobiotic collagen in a palisaded arrangement consistent with granuloma annulare (hematoxylin-eosin, original magnification ×100).

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