Indian Journal of Dermatology
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CASE REPORT
Year : 2011  |  Volume : 56  |  Issue : 6  |  Page : 752-754

Disseminated granuloma annulare: A cutaneous adverse effect of anti-TNF agents


School of Medicine, University of California Davis, Davis, CA, Department of Dermatology and Division of Rheumatology, Allergy and Clinical Immunology, VA Sacramento Medical Center, Sacramento, CA, USA

Correspondence Address:
Siba P Raychaudhuri
UC Davis, 1911 Geneva Place, Davis, CA 95618
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.91847

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Tumor necrosis factor-alpha (TNF-α) inhibitors, such as etanercept, infliximab, and adalimumab, bind to TNF-α and thereby act as anti-inflammatory agents. This group of drugs has been approved for the treatment of rheumatoid arthritis, psoriatic arthritis, moderate to severe plaque psoriasis, ankylosing spodylitis, Crohn disease, and juvenile idiopathic arthritis. We describe a 56-year-old woman who developed an erythematous pruritic rash on both arms-diagnosed as granuloma annulare by skin biopsy-approximately 22 months after initiating adalimumab for treatment of rheumatoid arthritis. On stopping adalimumab there was total clearance of the skin lesions, but a similar rash developed again when her treatment was switched to another anti-TNF agent (etanercept). This clinical observation supports a link between TNF inhibition and the development of granuloma annulare.


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