Psoralen and ultraviolet A in the treatment of granuloma annulare.

BACKGROUND: Granuloma annulare (GA) is a benign, usually self-limiting disease. Lesions may be localized or generalized with a tendency for generalized disease to follow a chronic course. There is evidence to support psoralen and ultraviolet A (PUVA) in the treatment of GA, but little data on long-term benefits. The purpose of this study was to investigate the effect of PUVA in the treatment of GA, and to establish clearance and remission rates.

METHODS: We carried out a retrospective study of patients with generalized GA treated with PUVA over 13 years. Data were collected from case notes and a phototherapy database. On completion of treatment, outcome was assessed as clear, good improvement, moderate improvement and poor outcome. Follow-up data were obtained for patients who had cleared using a postal questionnaire in addition to clinic notes.

RESULTS: Fifty per cent of courses resulted in clearance of disease, 16% in good improvement, 25% had moderate benefit and 9% had a poor outcome. Of the patients that cleared, 79% remained in remission at 6 months but only 32% were still clear 12 months following treatment.

CONCLUSION: Our findings show clearance or good improvement of generalized GA in 66% of cases. Prolonged remission, however, occurred in less than a third of patients.