TNF and Granuloma: The literature describes a broad therapeutic arsenal, ranging from local treatments such as tacrolimus, in addition to PUVA, photodynamic therapy, and systemic anti-inflammatory drugs and immunomodulators; in this context, TNF-α inhibitors show good effectiveness in controlling the formation of granulomas.1, 2 Adalimumab is a monoclonal antibody that binds to soluble TNF-α to prevent its interaction with TNF receptors on cell surfaces, thereby fixing the complement and inducing apoptosis in cells expressing TNF in vitro.3