Isotretinoin in the treatment of granuloma annulare.

OBJECTIVE: To assess the utility and safety of isotretinoin in the treatment of granuloma annulare (GA).

DATA SOURCES: Searches of MEDLINE (1966-January 2003), EMBASE (1989-January 2003), International Pharmaceutical Abstracts (1970-2002), and Allied and Complementary Medicine Database (1985-2002) were conducted. Key terms included granuloma annulare, isotretinoin, retinoids, and antioxidants.

DATA SYNTHESIS: Isotretinoin may have proliferative and inhibitory effects on collagen synthesis that improve GA symptoms. Cases reporting use of isotretinoin in the treatment of GA were reviewed. Several reports detail the successful use of isotretinoin 0.5-1 mg/kg/day, primarily in the disseminated form of the disease. However, some patients required dosage decreases in response to drug-related liver function test elevations, and 2 instances of drug failure were identified.

CONCLUSIONS: Isotretinoin should be reserved for patients with disseminated or refractory GA. Potential serious adverse effects associated with its use require careful monitoring.