Improvement of generalized granuloma annulare with adalimumab: A case report

Granuloma annulare is a benign, inflammatory condition of unknown etiology, characterized by erythematous annular plaques, frequently on distal extremities. Generalized granuloma annulare can be difficult to treat, with varying success in therapeutic approaches. We present the case of a 59-year-old female with refractory generalized granuloma annulare successfully managed with adalimumab, requiring ongoing 40 mg q2weekly treatment for 2 years. While there are a handful of published case reports/series suggesting that adalimumab can be used to treat generalized granuloma annulare, dosing regimens and the need for long-term use remain inconsistent. This case adds further evidence for considering adalimumab as a sustained therapeutic option for recalcitrant generalized granuloma annulare. The patient responded to adalimumab, a tumor necrosis factor-alpha antagonist, administered biweekly for a year, then switched to weekly intervals. Most granuloma annulare lesions improved within 2 months and continued to improve throughout the treatment. Adalimumab may be proposed as a therapeutic treatment for recalcitrant forms of generalized granuloma annulare.