Case and Research Letters
Successful Treatment of Disseminated Granuloma Annulare With Narrowband UV-B Phototherapy
Resolución de granuloma anular diseminado con fototerapia UVB de banda estrecha
G. Solano-López
, M.J. Concha-Garzón, D. de Argila, E. Daudén
Corresponding author
Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, Spain
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Solano-López, M.J. Concha-Garzón, D. de Argila, E. Daudén" "autores" => array:4 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Solano-López" "email" => array:1 [ 0 => "guitje1@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.J." "apellidos" => "Concha-Garzón" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "de Argila" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Daudén" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resolución de granuloma anular diseminado con fototerapia UVB de banda estrecha" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1121 "Ancho" => 2501 "Tamanyo" => 243708 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B, Right thigh and lumbar region after 27 treatment sessions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Disseminated granuloma annulare (DGA) is an inflammatory disease that tends to follow a chronic course and is resistant to multiple treatments.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 80-year-old woman with asymptomatic lesions that had developed 3 years earlier. The lesions initially developed on the arms, later spreading to the abdomen, back, and legs, and improved during the summer months. The patient had undergone treatment with topical corticosteroids for several weeks with no improvement. Her relevant medical history included hypertension and retinal detachment. Physical examination revealed well-defined, annular red-purple plaques several centimeters in diameter with a smooth surface and a raised edge (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, A and B). These plaques were much flatter in sun-exposed areas of the forearms and legs. A biopsy of one of the plaques on the arm showed lymphohistiocytic granulomas in the upper and middle dermis, with degeneration of connective tissue and mucin deposition associated with a lymphocytic inflammatory infiltrate, leading to a diagnosis of DGA. The patient was prescribed several cycles of oral prednisone (30<span class="elsevierStyleHsp" style=""></span>mg per day in decreasing doses for periods of 6 weeks) and topical corticosteroids (15 days) with no improvement. Although asymptomatic, the plaques were esthetically unpleasant; it was thus decided to treat the patient with phototherapy. Psoralen-ultraviolet-A (PUVA) therapy was ruled out as the patient had experienced 2 episodes of retinal detachment. The patient underwent narrowband ultraviolet-B (NB-UVB) phototherapy 3 times per week for 2.5 months, following a dose escalation protocol for skin phototype II. In total, 27 sessions were performed and the patient received a cumulative dose of 26.155<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>. The patient showed good tolerance and an excellent response, with the affected body surface area decreasing from 28 to almost 0 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>, A and B). Upon discharge, daily sun exposure was recommended.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">This is the second reported case of DGA treated with NB-UVB. The only other report in the literature describes a patient who underwent 24 weekly sessions, and received an accumulated dose of 15<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> While that patient́s lesions began to improve in the third week, their near total disappearance occurred only after treatment had ended, with no recurrences during 6 months of follow up. In our case, which involved a larger affected body surface area, a higher accumulated dose, and a shorter interval between sessions, the patient remains free of lesions after 1 year of follow up.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A lack of evidence-based treatment guidelines makes DGA treatment challenging for the dermatologist. Around 30 different treatments have been described, mostly in isolated cases or small series, and all with varying results. Among the most commonly used treatments are topical, oral, intralesional, and intramuscular corticosteroids, biological agents, surgery, laser treatment, and phototherapy.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Good results have been described with PUVA, retinoid PUVA, and UVA1.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In addition to being difficult to treat, recurrences are common in DGA. A retrospective study of 33 patients treated with PUVA found that while 66% showed improvements, most patients experienced recurrences within the first 2 years.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Although several treatment sessions are required for resolution, itching, if present, is relieved early on.</p><p id="par0030" class="elsevierStylePara elsevierViewall">NB-UVB phototherapy, with an emission spectrum of 311-313<span class="elsevierStyleHsp" style=""></span>nm, has been used for many years to treat psoriasis, and poses a lower risk of erythema and carcinogenicity than broadband UVB. Furthermore, it is well known that NB-UVB exerts a greater suppressive effect on lymphoproliferation and cytokine production than broadband UVB.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> NB-UVB has been shown to be safe and efficacious in the treatment of a growing number of dermatological diseases, even in pediatric populations.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Several variables should be considered when selecting systemic treatment for DGA, including the patient́s baseline blood evaluations, comorbidities, interactions with other drugs, potential adverse effects, and prior treatments.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Despite having found only one similar case reported in the literature,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> we believe that in cases like the present one, in which PUVA was contraindicated, treatment with NB-UVB phototherapy is worth attempting.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Solano-López G, Concha-Garzón MJ, de Argila D, Daudén E. Successful Treatment of Disseminated Granuloma Annulare With Narrowband UV-B Phototherapy. Actas Dermosifiliogr. 2015;106:240–241.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1044 "Ancho" => 2333 "Tamanyo" => 218422 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A and B, Right thigh and lumbar region before treatment.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1121 "Ancho" => 2501 "Tamanyo" => 243708 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B, Right thigh and lumbar region after 27 treatment sessions.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disseminated granuloma annulare responsive to narrowband ultraviolet B therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. 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Gerritsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.0906-6705.2003.00057.x" "Revista" => array:6 [ "tituloSerie" => "Exp Dermatol" "fecha" => "2003" "volumen" => "12" "paginaInicial" => "729" "paginaFinal" => "733" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14714551" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Narrowband UVB phototherapy for pediatric generalized pityriasis lichenoides" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V. Brazzelli" 1 => "A. Carugno" 2 => "N. Rivetti" 3 => "R. Cananzi" 4 => "S. Barruscotti" 5 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 20 | 11 | 31 |
| 2024 October | 129 | 67 | 196 |
| 2024 September | 158 | 49 | 207 |
| 2024 August | 197 | 98 | 295 |
| 2024 July | 181 | 65 | 246 |
| 2024 June | 181 | 71 | 252 |
| 2024 May | 137 | 55 | 192 |
| 2024 April | 132 | 41 | 173 |
| 2024 March | 168 | 36 | 204 |
| 2024 February | 135 | 54 | 189 |
| 2024 January | 114 | 45 | 159 |
| 2023 December | 110 | 26 | 136 |
| 2023 November | 100 | 39 | 139 |
| 2023 October | 123 | 45 | 168 |
| 2023 September | 109 | 37 | 146 |
| 2023 August | 111 | 49 | 160 |
| 2023 July | 117 | 52 | 169 |
| 2023 June | 99 | 43 | 142 |
| 2023 May | 98 | 35 | 133 |
| 2023 April | 94 | 42 | 136 |
| 2023 March | 118 | 40 | 158 |
| 2023 February | 90 | 34 | 124 |
| 2023 January | 70 | 32 | 102 |
| 2022 December | 78 | 40 | 118 |
| 2022 November | 25 | 44 | 69 |
| 2022 October | 32 | 24 | 56 |
| 2022 September | 29 | 47 | 76 |
| 2022 August | 43 | 41 | 84 |
| 2022 July | 77 | 40 | 117 |
| 2022 June | 72 | 30 | 102 |
| 2022 May | 105 | 35 | 140 |
| 2022 April | 137 | 32 | 169 |
| 2022 March | 168 | 58 | 226 |
| 2022 February | 119 | 21 | 140 |
| 2022 January | 154 | 43 | 197 |
| 2021 December | 85 | 29 | 114 |
| 2021 November | 92 | 39 | 131 |
| 2021 October | 77 | 56 | 133 |
| 2021 September | 79 | 33 | 112 |
| 2021 August | 83 | 23 | 106 |
| 2021 July | 63 | 32 | 95 |
| 2021 June | 99 | 52 | 151 |
| 2021 May | 79 | 37 | 116 |
| 2021 April | 250 | 36 | 286 |
| 2021 March | 184 | 25 | 209 |
| 2021 February | 76 | 31 | 107 |
| 2021 January | 83 | 35 | 118 |
| 2020 December | 86 | 26 | 112 |
| 2020 November | 45 | 15 | 60 |
| 2020 October | 72 | 14 | 86 |
| 2020 September | 53 | 7 | 60 |
| 2020 August | 56 | 18 | 74 |
| 2020 July | 54 | 18 | 72 |
| 2020 June | 41 | 33 | 74 |
| 2020 May | 30 | 26 | 56 |
| 2020 April | 45 | 19 | 64 |
| 2020 March | 37 | 19 | 56 |
| 2020 February | 7 | 5 | 12 |
| 2020 January | 4 | 3 | 7 |
| 2019 December | 8 | 7 | 15 |
| 2019 November | 4 | 5 | 9 |
| 2019 October | 1 | 3 | 4 |
| 2019 September | 9 | 6 | 15 |
| 2019 August | 4 | 10 | 14 |
| 2019 July | 2 | 6 | 8 |
| 2019 June | 6 | 12 | 18 |
| 2019 May | 2 | 88 | 90 |
| 2019 April | 0 | 57 | 57 |
| 2019 March | 3 | 15 | 18 |
| 2019 February | 3 | 8 | 11 |
| 2019 January | 3 | 5 | 8 |
| 2018 December | 1 | 10 | 11 |
| 2018 November | 1 | 6 | 7 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 3 | 4 | 7 |
| 2018 August | 0 | 10 | 10 |
| 2018 July | 0 | 10 | 10 |
| 2018 June | 0 | 7 | 7 |
| 2018 May | 0 | 7 | 7 |
| 2018 April | 0 | 8 | 8 |
| 2018 March | 0 | 12 | 12 |
| 2018 February | 59 | 16 | 75 |
| 2018 January | 103 | 19 | 122 |
| 2017 December | 85 | 11 | 96 |
| 2017 November | 79 | 24 | 103 |
| 2017 October | 97 | 30 | 127 |
| 2017 September | 57 | 17 | 74 |
| 2017 August | 48 | 23 | 71 |
| 2017 July | 51 | 21 | 72 |
| 2017 June | 55 | 33 | 88 |
| 2017 May | 51 | 18 | 69 |
| 2017 April | 38 | 16 | 54 |
| 2017 March | 38 | 35 | 73 |
| 2017 February | 38 | 36 | 74 |
| 2017 January | 31 | 21 | 52 |
| 2016 December | 47 | 23 | 70 |
| 2016 November | 57 | 27 | 84 |
| 2016 October | 40 | 28 | 68 |
| 2016 September | 0 | 17 | 17 |
| 2016 August | 0 | 15 | 15 |
| 2016 July | 11 | 4 | 15 |
| 2016 June | 17 | 1 | 18 |
| 2016 May | 16 | 18 | 34 |
| 2016 April | 9 | 1 | 10 |
| 2016 March | 8 | 1 | 9 |
| 2016 February | 8 | 2 | 10 |
| 2016 January | 15 | 7 | 22 |
| 2015 December | 17 | 4 | 21 |
| 2015 November | 8 | 3 | 11 |
| 2015 October | 6 | 3 | 9 |
| 2015 August | 0 | 11 | 11 |
| 2015 July | 14 | 1 | 15 |
| 2015 June | 3 | 3 | 6 |
| 2015 May | 5 | 7 | 12 |
| 2015 April | 5 | 17 | 22 |
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