Successful treatment of perforating granuloma annulare with 0.1% tacrolimus ointment

Perforating granuloma annulare (PGA) is a rare subtype of granuloma annulare (GA) named in 1971 by Owens and Freeman. It is characterized by necrobiotic areas surrounded by histiocytes and lymphocytes with transepidermal elimination. Many treatments for PGA have been used, often with unsatisfactory results. Tacrolimus in its topical formulation has been established as a safe and effective alternative to topical corticosteroids because of its mild side effects and its minimal systemic absorption. Topical tacrolimus has been approved for the treatment of atopic dermatitis; moreover, ample data exist which demonstrate the usefulness of tacrolimus for the specific treatment of other inflammatory diseases. We report a 70-year-old diabetic woman with PGA, in whom the ulceration due to PGA responded to 0.1% topical tacrolimus.