Methotrexate treatment of generalized granuloma annulare: a retrospective case series

Abstract

Background: 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. Objective: To evaluate the efficacy and adverse effects associated with methotrexate treatment of GGA. Methods: Descriptive retrospective case series of 11 patients with GGA receiving methotrexate. Results: 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. Limitations: 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. Conclusions: Methotrexate can be a successful and well-tolerated treatment option for patients with generalized GA.

Keywords

• methotrexate
• generalized granuloma annulare
• treatment-refractory
• case series