Granuloma annulare treated with certolizumab following the development of antidrug antibodies to adalimumab

Granuloma annulare (GA) is a chronic granulomatous skin disorder of unclear etiology characterized by annular plaques and erythematous papules.1 Although localized forms of GA may resolve spontaneously, the generalized variant is often chronic and resistant to therapy.2 First-line therapies often include antimalarials (eg, hydroxychloroquine), narrowband ultraviolet B, and intralesional triamcinolone, with adjuncts such as doxycycline or pentoxifylline for partial responders.3 Second-line treatments include tumor necrosis factor-alpha (TNF-α) inhibitors, which have been used off-label for recalcitrant GA and have shown efficacy in some cases.