Methotrexate treatment of generalized granuloma annulare: a retrospective case series

Management of generalized granuloma annulare (GGA) poses challenges for both patients and dermatologists. Currently, there are no established first-line therapies for GGA and the available therapeutic modalities are based on individual case reports and a few small case series. Further, there are limited publications assessing the efficacy of methotrexate in treating GGA.

To evaluate the efficacy and adverse effects associated with methotrexate treatment of GGA.

Descriptive retrospective case series of 11 patients with GGA receiving methotrexate.

Sixty four percent of patients receiving methotrexate noted improvement of their skin disease, of which 43% achieved complete clearance and 57% partial clearance. Initial dose of methotrexate ranged from 12.5 to 15 mg weekly, administered either orally or subcutaneously. The majority of patients tolerated the treatment well. However, 18% of patients experienced the adverse effects of either GI upset or hair loss.

This case series lacks a control group and therefore has low internal validity. The lack of a disease severity and therapy responsiveness measurement tool made quantifying disease improvement inexact.

Methotrexate can be a successful and well-tolerated treatment option for patients with generalized GA.