Stratman Scott, Amara Shivkar, Tan Kathryn Jayne, George-Washburn Elisabeth A, Shokrian Neda, Lau William, Khattri Saakshi, Lebwohl Mark, Yassky Emma Guttman
Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
Arch Dermatol Res. 2025 Apr 29;317(1):743. doi: 10.1007/s00403-025-04248-1.
Granuloma Annulare (GA) is an inflammatory granulomatous disorder that is typically localized to the skin. First line therapies for localized GA include topical and intralesional corticosteroids. Systemic corticosteroids have been used for generalized; however, rates of partial and complete resolution are disappointing. Recent advances in understanding the pathophysiology of macrophage activation and granuloma formation have led to Janus Kinase (JAK) inhibition as a therapeutic target for GA. The objectives of our study were to provide insight into the pathophysiology of GA and describe the clinical course and findings in patients with GA on JAK inhibitor therapy. This is a retrospective case series of 9 adults (age ≥ 18 years) with a diagnosis of GA and concomitant use of an oral JAK inhibitor. All patients on oral JAK inhibitor therapy (upadacitinib or abrocitinib) had improvement and/or clearance of their GA lesions within the first three months of therapy. Few adverse events commonly implicated in JAK inhibitor therapy (e.g., URI symptoms, malaise, acne) were reported. This study is limited by small sample size. JAK inhibitor therapy can be used in patients with GA, especially if they failed other treatments. Furthermore, JAK inhibitor therapy resulted in faster clearance time compared to other conventional treatments (e.g., antimicrobials, antimalarials, apremilast, methotrexate, and anti-tumor necrosis factor inhibitors). Depending on extent of GA involvement and patient-provider preferences, oral JAK inhibition therapy can be used off-label. Generally, these medications are well tolerated with few side effects compared to other GA treatment options.
环状肉芽肿（GA）是一种炎症性肉芽肿性疾病，通常局限于皮肤。局限性GA的一线治疗方法包括外用和皮损内注射皮质类固醇。全身性皮质类固醇已用于全身性GA；然而，部分和完全缓解率令人失望。在理解巨噬细胞活化和肉芽肿形成的病理生理学方面的最新进展已导致将Janus激酶（JAK）抑制作为GA的治疗靶点。我们研究的目的是深入了解GA的病理生理学，并描述接受JAK抑制剂治疗的GA患者的临床病程和表现。这是一项回顾性病例系列研究，研究对象为9名诊断为GA并同时使用口服JAK抑制剂的成年人（年龄≥18岁）。所有接受口服JAK抑制剂治疗（乌帕替尼或阿布昔替尼）的患者在治疗的前三个月内GA皮损均有改善和/或消退。报告的JAK抑制剂治疗中常见的不良事件很少（例如，上呼吸道感染症状、不适、痤疮）。本研究受样本量小的限制。JAK抑制剂治疗可用于GA患者，尤其是那些其他治疗失败的患者。此外，与其他传统治疗方法（例如，抗菌药物、抗疟药物、阿普米拉斯、甲氨蝶呤和抗肿瘤坏死因子抑制剂）相比，JAK抑制剂治疗导致皮损清除时间更快。根据GA累及的程度和患者与医生的偏好，口服JAK抑制治疗可用于非标签使用。一般来说，与其他GA治疗选择相比，这些药物耐受性良好，副作用很少。
