Antimalarial therapy for granuloma annulare: a systematic review

Granuloma annulare (GA) is a granulomatous skin disorder which presents with erythematous annular plaques with central clearing. There have been reports of anti-malarial agents used for systematic therapy in cases where other topical and systemic agents have failed. We aimed to summarize existing evidence regarding the efficacy of anti-malarial therapy for GA. A systematic review of existing studies was performed. All study types including case reports were included. A total of 10 studies were identified from systematic database searches, comprising 49 reported literature cases. There were 35 cases using hydroxychloroquine, 12 cases using chloroquine, and 2 cases which were treated with anti-malarial medication but unspecified. Overall, the efficacy rate of treatment with anti-malarial therapy was 79.6% (39 out of 49 cases). Subgroup analysis according to type of anti-malarial medication demonstrated a significantly higher efficacy rate for reported chloroquine cases (100%, 12 out of 12 cases) with improvement compared to hydroxychloroquine (71.4%, 25 out of 35 cases). There were no significant side effects reported in these cases. The evidence for anti-malarial therapy of GA is extremely limited. The data are promising however; anti-malarials should be considered as a possible treatment option for patients with generalized GA.