rifampin and Granuloma-Annulare

Topics: Anti-Bacterial Agents; Granuloma Annulare; Humans; Minocycline; Norfloxacin; Rifampin

Granuloma annulare (GA) is a benign, usually self-limiting, dermatosis, that typically presents as asymptomatic, flesh-colored or erythematous papules, frequently arranged in an annular or arciform pattern on the distal extremities. Although localized GA is most commonly observed, a generalized or disseminated form can occur. The etiology of GA is unknown; however, multiple inciting factors have been proposed. Histologically, GA is characterized by foci of degenerative collagen associated with palisading, sometimes infiltrating granulomatous inflammation.. We report 6 cases with biopsy-proved GA, resistant to the standard modalities of treatment that resolved after 3 months with monthly rifampin (600 mg), ofloxacin (400 mg), and minocycline hydrochloride (100 mg) combination therapy. Rifampin, ofloxacin, and minocycline combination therapy has been successfully used to treat patients with paucibacillary leprosy. Given reports that prolonged antibiotic agents are a useful treatment for GA, rifampin (600 mg), ofloxacin (400 mg), and minocycline hydrochloride (100 mg) combination therapy was initiated in these patients. Complete clearance of the plaques was achieved 3 to 5 months after the initiation of treatment. Some patients experienced postinflammatory hyperpigmentation.. Although our treatment was effective, further studies may be needed to confirm the success of this therapeutic option for patients with recalcitrant lesions of GA.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Granuloma Annulare; Humans; Male; Middle Aged; Minocycline; Ofloxacin; Rifampin

At one time it was believed that granuloma annulare was associated with or even caused by tuberculosis. In the past 50 years, that idea has seemed to be of little more than historic importance. A case is reported of chronic, inadequately treated tuberculosis with erythema induratum in which clinical and histologic lesions compatible with granuloma annulare occurred. Specific antituberculosis therapy caused clearing of the skin lesions. The previous reported cases of granuloma annulare and tuberculosis are summarized. Other systemic diseases reportedly associated with granuloma annulare are noted to emphasize the many possible etiologic relationships. Granuloma annulare may be viewed not as a disease sui generis but as a phenotypic macrophage-granulomatous response to multiple etiologic disease patterns.

Topics: Antitubercular Agents; Back; Diagnosis, Differential; Erythema; Female; Granuloma Annulare; Humans; Leg Ulcer; Middle Aged; Phenotype; Radiography; Rifampin; Tuberculosis, Pulmonary