QIs isotretinoin effective for the treatment of generalized granuloma annulare?

Richard Winkelmann, DO

Richard Winkelmann, DO

Director for Dermatology and Mohs Surgery
Optum Care
Los Angeles, CA

Some cases of generalized granuloma annulare are refractory to therapy with cyclosporine, hydroxychloroquine and other immunosuppressives. Isotretinoin has also been studied as an effective therapy for refractory generalized granuloma annulare. Although not thoroughly studied, the therapeutic benefit is thought to be due to the prolific and inhibitory effects of isotretinoin on collagen synthesis. Systematic reviews detail benefit with doses of 0.5-1 mg/kg/day with variable durations of therapy. When treating patients for generalized granuloma annulare using isotretinoin, I opt for monthly liver function tests to monitor closely for systemic toxicity.


  1. Looney M, Smith KM. Isotretinoin in the treatment of granuloma annulare. Ann Pharmacother. 2004;38(3):494-497. doi:10.1345/aph.1D312