Factors Associated With Treatment Response in Granuloma Annulare

Area of Science:

• Dermatology
• Inflammatory Dermatoses
• Cutaneous Medicine

Background:

• Granuloma annulare (GA) is a chronic inflammatory skin condition with limited treatment options and variable efficacy.
• Established treatments for GA often yield inconsistent response rates.
• The Goeckerman protocol, combining coal tar, phototherapy, and topical corticosteroids (TCS), is effective for other inflammatory dermatoses but unstudied in GA.

Purpose of the Study:

• To evaluate treatment outcomes for granuloma annulare (GA) across various therapeutic modalities.
• To compare the efficacy of the Goeckerman protocol against other standard GA treatments.
• To identify clinical factors associated with treatment response in GA patients.

Main Methods:

• Retrospective cohort study of 240 patients with biopsy-confirmed GA (2010-2024).
• Treatment groups included topical corticosteroids (TCS), phototherapy, combination therapy, Goeckerman protocol, and observation.
• Dermatologist assessment of treatment response (complete, partial, none) and multivariate logistic regression analysis.

Main Results:

• The Goeckerman protocol achieved a 93.5% response rate, significantly higher than other modalities.
• Overall response rate was 58.2%; Goeckerman protocol (93.5%), TCS + phototherapy (69.6%), TCS alone (56.3%), observation (32.4%), and phototherapy alone (16.7%).
• The Goeckerman protocol was the strongest predictor of treatment response (OR 32.52, p<0.001), followed by combination therapy and TCS.

Conclusions:

• Treatment modality is the primary factor influencing treatment response in granuloma annulare (GA).
• The Goeckerman protocol demonstrated superior efficacy compared to other evaluated therapies for GA.
• Intensive multimodal anti-inflammatory therapy, such as the Goeckerman protocol, shows promise for treating GA, despite potential selection bias in retrospective analysis.