Case of Generalized Granuloma Annulare Treated with Low Dose Naltrexone + PUVA

Granuloma annulare (GA) is a common, noninfectious granulomatous skin condition that usually presents in its localized form, characterized by flesh-colored to erythematous papules coalescing into annular plaques without scale, commonly on the dorsal hands. Lesions can be pruritic and often resolve treatment two years. However, generalized form of GA has lower incidence with similar morphology, but >10 lesions widespread distribution. Generalized known more symptomatic, longer-lasting, recalcitrant treatment. The diagnosis made based clinicopathological correlation palisading granulomas around degenerated collagen dermis, mucin, infiltrative lymphocytes histiocytes. Treatment remains challenging as evidence limited case reports, series, few retrospective studies. Here we present 59-year-old Caucasian female rash began her abdomen spread extremities over months. Biopsy revealed superficial histiocytic infiltrates eosinophilic areas altered collagen, multiple multinucleate giant cells elastophagocytosis lymphohistiocytic perivascular infiltrates, mucin dermis colloidal iron staining. Overall, this was consistent GA. patient started combination low dose naltrexone (LDN) psoralen ultraviolet A (PUVA) therapy. At five-month follow up visit, she demonstrated near complete resolution symptoms any serious adverse effects.