Treatment of disseminated granuloma annulare with pulse therapy upadacitinib

Granuloma annulare (GA) is an idiopathic inflammatory skin condition with a chronic and unpredictable course. Although localized GA is usually cleared with topical or systemic corticosteroids, generalized GA is often difficult to treat owing to the lack of treatment options and recurrence with treatment. Recent evidence has helped to elucidate the etiology behind GA, with growing confirmation for the use of JAK inhibitors as a possible treatment for GA. We present a 61-year-old woman with recalcitrant GA who responded successfully to pulse therapy upadacitinib, a JAK1 inhibitor. Our findings demonstrate the utility of this alternative and practical treatment strategy that may reduce the cumulative toxicity of upadacitinib and optimize its risk/benefit ratio.