Treatment of refractory generalized granuloma annulare with oral vitamin E and topical tea tree oil

Generalized granuloma annulare (GA) is an uncommon form of GA that is recalcitrant to treatment.1In contrast to localized GA, the generalized form is characterized by widespread annular plaques or papules over the trunk and extremities.1 Although the lesions are frequently asymptomatic, the lesions can be disfiguring and decrease the patient’s quality of life. Therefore, extensive disease might justify more aggressive treatment. We report a patient with generalized GA resistant to conventional treatments who experienced dramatic improvement with oral vitamin E and topical tea tree oil (TTO).