Pentoxifylline as a Steroid-Sparing Agent in Granuloma Annulare: A Rural Retrospective Study

Granuloma annulare (GA) is a benign inflammatory dermatosis characterized by dermal granuloma formation. While its etiology is unclear, GA has been linked to systemic comorbidities. Localized GA typically responds to corticosteroids, but generalized GA often follows a more refractory course. Pentoxifylline has emerged as a potential steroid-sparing agent, though data are limited.

A retrospective chart review was conducted on 102 patients diagnosed with GA at a single academic dermatology clinic in rural Appalachia. Demographic data, disease subtype, treatment history, and comorbidities were recorded. Comorbidity prevalence was compared with state and national averages. Statistical analysis assessed associations between disease extent, treatment response, and comorbidity burden.

The cohort was 79% female with a mean age of 46 years; 19% of cases were pediatric. Generalized GA accounted for 46% of cases and showed elevated rates of type 2 diabetes (36%), hypothyroidism (26%), and autoimmune disease (15%). Patients with ≥3 comorbidities were more likely to have prolonged disease (>2 years). Generalized GA required more treatment attempts (P<0.001) and had higher failure rates than localized disease. Pentoxifylline achieved a 64% response rate in generalized GA, outperforming hydroxychloroquine and topical corticosteroids.

Generalized GA is more treatment-resistant and associated with a greater comorbidity burden. Pentoxifylline demonstrated favorable efficacy and may serve as a first-line systemic agent in refractory cases. Further multi-center studies are needed to validate these findings and guide evidence-based management of GA.  .