Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.
Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
Photodermatol Photoimmunol Photomed. 2022 Jul;38(4):301-310. doi: 10.1111/phpp.12756. Epub 2021 Dec 15.
Granuloma annulare (GA) is challenging to treat, especially when generalized. A systematic review to support the use of light- and laser-based treatments for GA is lacking.
We performed a systematic review by searching Cochrane, MEDLINE, and Embase. Title, abstract, full-text screening, and data extraction were done in duplicate. Quality appraisal was performed using the Joanna Briggs Institute critical appraisal tool for case series.
Thirty-one case series met the inclusion criteria, representing a total of 336 patients. Overall, psoralen ultraviolet light A (PUVA) showed the greatest frequency of cases with complete response (59%, n = 77/131), followed by photodynamic therapy (PDT) (52%, n = 13/25), ultraviolet light B (UVB)/narrowband UVB (nbUVB)/excimer laser (40%, n = 19/47), UVA1 (31%, n = 27/86), and lasers (29%, n = 8/28). Overall across treatment modalities, higher response rates were seen in localized GA compared to generalized GA.
The body of evidence for light- and laser-based treatment of GA is sparse. Our results suggest that PUVA has a high clearance rate for GA but its use may be limited by concerns of carcinogenesis. Although PDT has the second highest clearance rate, adverse effects, small sample sizes, impractical treatment delivery (especially with generalized disease), and long-term concerns of carcinogenesis may limit its use. Although UVB/nbUVB/excimer laser appeared slightly less effective than other light therapies, we recommend UVB/nbUVB/excimer laser therapy as a first-line treatment for patients with generalized GA given wider availability and a favorable long-term safety profile.
环状肉芽肿（GA）的治疗具有挑战性，尤其是当它是全身性的。目前缺乏支持光和激光治疗 GA 的系统评价。
我们通过搜索 Cochrane、MEDLINE 和 Embase 进行了系统评价。标题、摘要、全文筛选和数据提取均由两人进行。使用 Joanna Briggs 研究所病例系列的批判性评估工具进行质量评估。
31 项病例系列符合纳入标准，共代表 336 名患者。总体而言，补骨脂素加紫外线 A（PUVA）显示出完全缓解的病例频率最高（59%，n=77/131），其次是光动力疗法（PDT）（52%，n=13/25）、中波紫外线 B（UVB）/窄带 UVB（nbUVB）/准分子激光（40%，n=19/47）、长波紫外线 A（UVA1）（31%，n=27/86）和激光（29%，n=8/28）。总体而言，在局部 GA 中，治疗效果高于全身性 GA。
光和激光治疗 GA 的证据不足。我们的结果表明，PUVA 对 GA 的清除率较高，但由于致癌风险的担忧，其使用可能受到限制。虽然 PDT 的清除率第二高，但不良反应、样本量小、治疗方法不切实际（特别是对于全身性疾病）以及长期致癌风险的担忧可能限制其使用。尽管 UVB/nbUVB/excimer 激光的效果似乎略低于其他光疗，但鉴于其广泛的可用性和良好的长期安全性，我们建议将其作为治疗全身性 GA 的一线治疗方法。
