TABLE 3.

Prescription medicines with limited efficacy and evidence-base

TREATMENT	INDICATION	RATIONALE	EVIDENCE BASE	LIMITATIONS
Allopurinol	Cutaneous sarcoidosis Granulomas related to implant fillers, usually at a high dose 450–600 mg/d67	Act as free radical scavengers. Free radicals are supposed to play an important role in the pathogenesis of granulomatous diseases	Case reports	May cause granulomas No evidence of efficacy in HA
Antihistamine	Type 1 hypersensitivity reactions Urticaria	Antihistamines may exert anti-inflammatory and immunoregulatory actions Some rationale for use but scientific evidence is lacking4	None (consensus recommendation)	Lack of effect
5-fluorouracil	Recalcitrant granulomas Steroid sparing	An inhibitor of DNA and RNA synthesis Mechanism in treatment of granulomas may relate to antimicrobial and anti-inflammatory properties Believed to inhibit structural formation of biofilms by interacting with regulatory genes vital to biofilm configuration15	None (consensus recommendation)	Concerns about safe use and disposal
Hydroxychloroquine	Granuloma	Anti-inflammatory and immunoregulatory properties	Cohort (but part of poly-therapy)70	Ophthalmic monitoring
Imiquimod	Cutaneous granulomas4	Immune cell activation	Case report relating to silicone granuloma	Many side-effects No evidence of efficacy in HA
Isotretinoin	Recalcitrant granulomas	Anti-inflammatory and immunoregulatory properties Downregulates overproduction of proinflammatory cytokines4	Case reports69	No evidence of efficacy in HA
Tacrolimus / Pimecrolimus	Corticosteroid resistant granuloma3 Hypersensitivity nodules70	Inhibits T-cell signal transduction and IL-2 production4	None (consensus recommendation)	Limited by topical application

Note: n=number of subjects; significant different if p<0.05