What’s New in the Medicine Chest: Granuloma Annulare

In a recent presentation at Winter Clinical Miami, Jim Del Rosso, DO, a dermatologist and clinical researcher based in Las Vegas, Nevada, shed light on the evolving landscape of granuloma annulare (GA), a condition that, while commonly encountered in dermatological practice, presents significant therapeutic challenges. Granuloma annulare, particularly in its localized and generalized forms, remains a condition with limited understanding of its pathophysiology and few established treatment options.

To start, Del Rosso highlights that even widely used treatments like topical corticosteroids require careful management regarding duration and application site, with varying efficacy depending on the patient’s age and disease presentation. For more resistant and generalized cases, emerging treatments are making their way into the spotlight, albeit as off-label options.

The use of Janus kinase (JAK) inhibitors is gaining prominence in literature as a potential therapeutic pathway for granuloma annulare. Del Rosso shared a case study involving a patient with refractory GA who responded well to topical ruxolitinib cream, a JAK inhibitor approved for vitiligo and atopic dermatitis but not for granuloma annulare. The patient showed notable improvement, supported by photographic evidence and existing case reports.

Oral JAK inhibitors, such as abrocitinib and upadacitinib, have also demonstrated promise in managing generalized GA. Del Rosso discussed cases where these therapies, originally approved for atopic dermatitis, showed significant efficacy in patients with resistant granuloma annulare. Despite the off-label nature of these treatments, their ability to achieve measurable improvement, even in protracted cases, offers a glimmer of hope for patients and clinicians alike.

Del Rosso emphasized the importance of staying aware of emerging literature and case reports to provide evidence-based care for granuloma annulare. While these treatments are not yet approved for GA, their effectiveness in refractory cases underscores the need for further research and exploration of novel therapeutic avenues.

To read and listen to more of our conference coverage, click here.

Click here for more insights from Del Rosso, including the full interview with Dermatology Times on his presentation at Winter Clinical 2025.