A case of granuloma annulare resolution with upadacitinib and review
DOI:
https://doi.org/10.25251/b84tff68Keywords:
granuloma, granuloma annulare, granulomatous disease, immunomodulators, inflammation/ inflammatory, JAK-STAT, narrowband, tofacitinib, JAK inhibitor (JAKI)Abstract
Granuloma annulare (GA) is a chronic dermatologic condition which may be poorly responsive to treatment and impose a significant psychological burden. A 74-year-old female presented to dermatology clinic with pink, annular skin lesions on her legs, arms, and back, persisting for five years and causing distress due to their appearance. Biopsy confirmed the clinical diagnosis of GA. The patient underwent numerous treatments without improvement, including clobetasol ointment, tacrolimus ointment, hydroxychloroquine, doxycycline, adalimumab, narrowband UVB phototherapy, and UVA1 phototherapy. Given her lack of response to prior established therapies, she was started on upadacitinib, a JAK1 (Janus Kinase) selective inhibitor, for its action on JAK-STAT (Janus kinase-signal transducer and activator of transcription) related cytokines upregulated in GA. Within 2 months she reported initial signs of improvement and flattening of her lesions and at her 3 month follow up visit, only post inflammatory pigmentary changes were noted on exam. This improvement was sustained during her 10-month course of treatment and at last follow up 3 months off treatment. JAK inhibitors have emerged as potential therapies for treatment-resistant GA, and we review the literature to date on their use in this setting. This case of extensive body surface area involvement and dramatic response to upadacitinib adds to the clinical experience of using selective JAK inhibition for recalcitrant GA.
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Copyright (c) 2026 Tatiana Sheppard, Peggy A. Wu, Anita S. Savell (Author)
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