Pimecrolimus 1% cream in the treatment of disseminated granuloma annulare

Conflicts of interest: none declared. Sir, Generalized granuloma annulare (GA) is an uncommon benign cutaneous disease of unknown origin. The eruption is characterized by numerous skin‐coloured to erythematous papules, usually on the trunk and extremities, which demonstrate a tendency to annular grouping and a potential to involve virtually any area of the skin. No consistent association between generalized GA and internal disease has been shown to date, although some reports support an association with diabetes mellitus, malignancies, thyroid disease, drug allergy, hypertension, arthritis, AIDS and other conditions.1 Generalized GA, although generally considered a disseminated form of localized GA, differs from the localized form by a later age at onset, protracted course, and poor response to therapy. Spontaneous resolution is rare: it has been reported in just two of 100 patients in the largest cohort of patients with generalized GA studied.1 Therapy has been largely disappointing despite sporadic reports of limited success with topical and intralesional corticosteroids, systemic corticosteroids, potassium iodide, niacinamide, psoralen plus ultraviolet A, systemic retinoids, hydroxychloroquine, dapsone, vitamin E, sulphones and topical tacrolimus.2–5