Treatment of Disseminated Granuloma Annulare with Oral Vitamin E: ‘Primum Nil Nocere'

<b><i>Background:</i></b> Disseminated granuloma annulare (DGA) is a benign and usually asymptomatic skin disease. However, many patients feel aesthetically disfigured and ask for treatment. Until today, no standard therapy is recommended. <b><i>Objective:</i></b> To evaluate the safety and efficacy of oral vitamin E treatment compared to the natural course of DGA. <b><i>Methods:</i></b> This single-centre observational cohort study included 38 consecutive patients with histologically confirmed DGA. 21 patients underwent treatment with oral vitamin E, whereas 17 patients preferred a wait-and-see approach. <b><i>Results:</i></b> Complete healing (40%) and improvement (30%) were frequently seen under oral vitamin E therapy. However, DGA also spontaneously disappeared in 31% and improved in 25% of untreated control patients. Vitamin E therapy was very well tolerated. <b><i>Conclusions:</i></b> Oral vitamin E treatment is a safe and probably effective therapy for DGA. As the natural course of DGA leads to complete healing or significant improvement in many cases, ‘primum nil nocere' should be the maxim.