Generalized granuloma annulare successfully treated with apremilast: report of two cases and literature review

Dear Editor, Generalized granuloma annulare (GGA) is a granulomatous necrobiotic inflammatory condition characterized by widespread annular lesions involving trunk and limbs with variable disease course and frequently associated with endocrinological, neoplastic, and infectious diseases. Patho-mechanism is likely based on T-helper-1 cytokines and often the course is persistent despite several empirical therapies. Apremilast is an oral phosphodiesterase-4 (PDE-4) inhibitor approved by EMA for the treatment of moderate to severe plaque psoriasis and psoriatic arthritis. Recently few cases of GGA treated with this small molecule were reported considering its ability to reduce the T-helper-1 cytokines.