Generalized Granuloma Annulare Improved by Narrow Band UVB Therapy

Abstract

Two patients, 75-year-old (case1) and 71-year-old (case2) women had a 4-year- and 1-year-history, respectively, of papules and annular erythematous eruptions on the body and extremities. Histological examinations revealed typical findings of granuloma annurale, showing the degeneration of connective tissues surrounded by histiocytes or epithelioid cells and associated with perivascular infiltrations of lymphocytes in the upper and mid dermis. In both patients, there were no past and present histories of diabetus mellitus. Topical application of steroid ointments had been used without satisfactory therapeutic effect. Narrow-band UVB phototherapy was started with initial doses of 400 mJ/cm² (case 1) and 300 mJ/cm² (case 2). Then, UVB dose was gradually increased up to 900mJ/cm² and to 800mJ/cm², respectively. At total exposures of 21 (15.1 J/cm²) and 35 (21.5 J/cm²) treatments, the skin changes subsided almost completely without adverse effects. Thereafter, no recurrences were observed during maintenance therapy with Narrow-band UVB. Narrow-band UVB phototherapy is easy to use, since, in contrast to PUVA, there is no need for the intake of photosensitizers and for photoprotection of skin and eyes on treatment days.