Actinic Granuloma Research Articles

Successful treatment of actinic granuloma with intralesional steroid injection: a case report

Successful treatment of actinic granuloma with intralesional steroid injection: a case report

Bilateral Conjunctival Actinic Granuloma With Necrobiotic Vasculitic Pattern: A Diagnosis of Exclusion.

A 53-year-old Caucasian male presented with an inflamed-appearing limbal nodule in his OD, clinically compatible with nodular episcleritis, that was unresponsive to topical corticosteroid therapy. Excisional biopsy of the lesion was performed and histopathological examination revealed foci of necrotizing vasculitis and granulomatous inflammation in a background of intense actinic elastosis. Infectious stains for organisms were negative. A comprehensive systemic evaluation for vasculitides was negative. Three years later, the patient returned with a clinically and histopathologically identical lesion in his OS. Systemic evaluation was noncontributory again, and a diagnosis of bilateral conjunctival actinic granuloma with necrobiotic vasculitic pattern was made.

Papular variant of actinic granuloma: a case report

Annular elastolytic giant cell granuloma (AEGCG) is an uncommon granulomatous skin disease characterized by giant cells in the dermis phagocytosing damaged elastin fragments, found mostly in areas that are more commonly exposed to sunlight. Asymptomatic annular plaques is the most common clinical presentation, although rare reports of a papular variant of AEGCG exist [1, 2]. We report a case of annular elastolytic giant cell granuloma papular variant with a history of allergies and intensive photodamage.

A Retrospective Study of 105 Patients with Elastolytic Giant Cell Granuloma and a Proposal for a New Clinical Classification.

Elastolytic giant cell granuloma, an idiopathic granulomatous dermatosis, is characterized by annular plaques on sun-exposed areas, and has been termed actinic granuloma or annular elastolytic giant cell granuloma. Many atypical clinical manifestations and lesions involving sun-protected areas have been reported. The aims of this retrospective study of 105 patients were to summarize the clinical and histological features of patients with this condition; to provide evidence for the viewpoint that elastolytic giant cell granuloma is a better term to include all clinical morphological types presenting with elastolysis, elastophagocytosis, and an infiltrate of multinucleated giant cells histologically; and to establish a new clinical classification. The varying clinical manifestations were further categorized into annular, papular, giant, mixed and generalized forms. The pathological manifestations were classified into giant cell, necrobiotic, histiocytic, sarcoidal and mixed patterns. Diabetes mellitus or impaired glucose tolerance were the most commonly identified comorbidities. Oral low-dose corticosteroid may be an effective treatment.

Actinic Granuloma of the Conjunctiva: Case Series and Review of the Literature

To characterize the clinical and histopathologic features of actinic granuloma of the conjunctiva. Retrospective observational case series METHODS: Institutional pathology records between 2014 and 2020 were searched for all cases of conjunctival actinic granuloma. Information collected included age, sex, ocular and medical history, clinical findings, laboratory workup, treatment, follow-up, pathologic diagnosis, and histopathologic inflammation pattern. Eight eyes of 8 patients, 5 men and 3 women, with a median age of 43 years (mean 49, range 24-83) were identified. Clinical diagnosis was pterygium (n=4, 50%), inflamed pterygium (n=1, 13%), pterygium vs conjunctival squamous cell carcinoma (n=1, 13%), episcleritis vs inflamed pinguecula (n=1, 13%), and scleritis vs keratoacanthoma (n=1, 13%). Of 5 lesions with follow-up information, none recurred following excision with a median follow-up of 9 weeks (mean 19 weeks, range 1-61 weeks). Allergy/atopy was documented in 4 of 7 (57%) patients with available medical information. There were no other systemic associations. Histopathologically, actinic granuloma was associated with pterygium (n=6, 75%) and pinguecula (n=2, 25%). All lesions were composed predominantly of histiocytes and a variable number of foreign body-type giant cells associated with a focus of severe actinic elastosis. The inflammatory pattern was giant cell (n=4, 50%), sarcoidal (n=2, 25%), histiocytic (n=1, 13%), and combined histiocytic and sarcoidal (n=1, 13%). Conjunctival actinic granuloma has diverse clinical and histopathologic manifestations, which need to be distinguished from other autoimmune, neoplastic, and infectious etiologies. This lesion frequently occurs in pre-existing pterygium and pinguecula and may be associated with allergy and atopy.

Actinic granuloma successfully treated with low-dose doxycycline

Actinic granuloma successfully treated with low-dose doxycycline

The role of biologics in the treatment of chronic granuloma annulare.

Granuloma annulare (GA), a benign inflammatory skin disease, is considered a Th1-type delayed hypersensitivity reaction. Localized GA is likely to resolve spontaneously, whereas disseminated GA (DGA) may persist for decades and can be resistant to treatment. Biologics including TNF-α inhibitors have been proposed and utilized as salvage therapy for GA and other related diseases, interstitial granulomatous dermatitis (IGD), and actinic granuloma (AG). A systematic review was conducted using the combination of search terms "granuloma annulare," "interstitial granulomatous dermatitis," or "actinic granuloma" and either "biologics," "etanercept," "adalimumab," "infliximab," "ustekinumab," "ixekizumab," "secukinumab," "guselkumab," "golimumab," "brodalumab," "tildrakizumab," or "certolizumab" from the years 1970-2017. Review of the literature revealed that 79.3% of the patients with GA, IGD, or AG who had been treated with demonstrated TNF-α inhibitor therapy a clinical response. TNF-α inhibitor therapy has been used to treat chronic GA, IGD, and AG that involved extensive body surface areas. However, the literature is limited to case series lacking control groups. Randomized, controlled trials are required to establish evidence-based treatment of GA and related cutaneous, granulomatous conditions.

Successful Treatment of Actinic Granuloma With Pulsed-Dye Laser and Fractionated Carbon Dioxide Laser.

Successful Treatment of Actinic Granuloma With Pulsed-Dye Laser and Fractionated Carbon Dioxide Laser.

Granulome annulaire élastolytique à cellules géantes : étude anatomoclinique

Annular elastolytic giant cell granuloma (AEGCG), a rare entity first described in 1979, is very similar to O'Brien actinic granuloma (AG), first described in 1975. Since then, many cases have been published under one or other of the two names. We performed a single-centre histopathology study to identify the distinguishing features and determine whether there was any objective difference between AEGCG and AG. Cases classed as AEGCG or AG at the dermatopathology laboratory in Strasbourg were included and analysed using haematoxylin-eosin, orcein and Alcian blue staining. The diagnosis was made in the event of granuloma rich in multi-nucleated giant cells and reduction or disappearance of elastic tissue. Clinical data were collected from the analysis requests and clinical files. We identified 73cases: 12classed as AEGCG and 61classed as AG. Mean age was 60.5years with a sex ratio of 0.55. The duration of the disease ranged from 8days to 17years. A single lesion was seen in 52% of cases with multiple lesions in the remaining cases. Lesions measured between 0.3 and 10cm and exhibited a predilection for photo-exposed areas, chiefly on the head, neck and upper limbs. In most cases, an annular erythematous edge was seen together with a light centre, and slow centrifugal spread. The diagnosis was made by a clinician in only 5.5% of cases. These granulomas were chiefly in the superficial and mid dermis and only rarely deep, and contained numerous giant cells with a constant contingent of lymphocytes, but plasma cells were also seen in half of the cases. Orcein staining revealed marked decrease or total disappearance of elastic tissue within the granulomatous area together with elastophagocytosis in practically all images. More rarely, there was evidence of necrobiosis, palisading granuloma, vascular involvement or orcein-stained asteroid bodies. There were no notable clinical or histological differences between the cases initially classed as AEGCG or AG. AEGCG is a separate entity from annular granuloma that must be assimilated with O'Brien actinic granuloma. The central role of elastic fibres seems clear, but that of ultraviolet radiation remains more controversial. The term annular elastolytic giant cell granuloma seems more appropriate since it is more descriptive and carries no physiopathological implications. There appears to be a significant association with sarcoidosis and with diabetes in a minority of cases, thus warranting screening for these diseases.

Differences between actinic granuloma and annular elastolytic granuloma: Two cases to learn

Differences between actinic granuloma and annular elastolytic granuloma: Two cases to learn

Spectrum and clinical variants of giant cell elastolytic granuloma.

Giant cell elastolytic granuloma, also known as annular elastolytic giant cell granuloma or actinic granuloma, is histologically characterized by elastophagocytosis. Recent studies have revealed various clinical presentations in both sun-exposed and non-sun-exposed areas. To clarify clinical characteristics based on case series observation. We retrospectively reviewed patients who fulfilled the pathological diagnosis criteria for giant cell elastolytic granuloma seen at Mackay Memorial Hospital from 2000 to 2014. Patient characteristics, clinical presentation, duration, associated diseases, treatment, and prognosis were analyzed. A total of 22 patients were analyzed and categorized into three major variants. Eight patients with the "annular form" showed large annular lesions, which were usually associated with sun exposure. Six patients with the "papular form" presented with small papules. Eight patients in the "mixed form" group exhibited both papules and smaller annular plaques. The papular form had the youngest age of onset and shortest disease duration. The known consequences in 19 patients were resolved in seven, improved in three, recurred in four, and persisted in five patients. The term "giant cell elastolytic granuloma" is more appropriate because these were not completely related to actinic changes and may be nonannular. The papular form is not easily recognizable without a biopsy.

Noninfectious granulomatous dermatoses: A puzzle for dermatologists and histopathologists

Background: Noninfectious granulomatous dermatoses (NGDSs) are a broad group of distinct reactive inflammatory conditions that share clinical as well as histological similarities. Because of these similarities, these lesions pose a diagnostic difficulty to naοve and even expert dermatologists and pathologists and need a clinicopathological correlation. Aims and Objectives: We aimed at determining the histopathological profile of NGDS in Western Indian population correlating it with morphology, age, and anatomic distribution with an attempt to find the etiology. Materials and Methods: In a prospective study conducted over 2 years in a tertiary care referral center in Mumbai, out of 1872 skin biopsies received, 29 histopathologically diagnosed cases of NGDS were selected and studied for histopathological features of granuloma. A clinico-histopathological correlation was attempted. Results: Out of the total 1872 skin biopsies received in our department in 2 year period, 29 biopsies were histopathologically diagnosed as NGDS of which necrobiotic granulomas ( n = 14) were the most common diagnosis which included granuloma annulare (78.57%), necrobiosis lipoidica (14.29%), and rheumatoid nodule (7.14%). Other frequently diagnosed lesions were sarcoidosis (13.79%), actinic granuloma (10.34%), erythema nodosum (6.89%), and erythema induratum (3.44%). Conclusions: Various NGDS exhibit histopathological features with considerable overlap. However, their knowledge is must to understand the clinical behavior. Similarly, detailed clinical history and examination of early and mature lesions help in differentiating between lesions sharing similar histological features.

A case of widespread actinic granuloma with associated drug-induced lupus erythematosus

A case of widespread actinic granuloma with associated drug-induced lupus erythematosus

UTILIDADE DA GRISEOFULVINA NO TRATAMENTO DO GRANULOMA ACTÍNICO DE O’BRIEN

O granuloma actiníco de O’Brien, ou também chamado de granuloma anular elastolítico de células gigantes é uma afecção rara. Apresenta-se clinicamente como pápulas que se confluem formando lesões anulares com centro atrófico. Histologicamente, evidencia-se elastofagocitose e elastólise. O seguinte caso relata uma paciente com 53 anos, que apresentava lesões clínicas e histopatológicas clássicas de granuloma actínico que evoluiu com melhora importante no tratamento adjuvante com griseofulvina.

Infiltrated papules on the trunk and headaches: A case of actinic granuloma and a review of the literature.

Actinic granuloma is a rare granulomatous reaction that is more commonly seen in females and thought to occur as an autoimmune response to actinic damage of elastic tissue. We discuss a case of a patient with actinic granuloma presenting with concomitant temporal arteritis. Our case and review of the literature emphasize the association between actinic granuloma and temporal arteritis, a serious inflammatory condition that could lead to blindness if misdiagnosed.

Elastolytic Actinic Giant Cell Granuloma.

Actinic granuloma and annular elastolytic giant cell granuloma are different terms used to define skin lesions characterized by elastolysis, elastophagocytosis, and multinucleated giant cell infiltrate. The clinical appearance varies from papules to annular plaques. Although elastolytic actinic giant cell granuloma shares some clinical features with granuloma annulare, they can be differentiated by histopathologic findings. The disease is initiated by an immune response triggered by different factors that alter the elastic tissue. The course tends to be chronic, with variable response to treatments, although spontaneous remission may occur. Diabetes mellitus is the systemic disease most frequently associated with this condition.

Actinic granuloma arising from the pulsed dye laser-treated skin in a patient with capillary malformation.

Dear Editor: Actinic granuloma is a rare inflammatory skin disorder that presents in chronically sun-damaged skin with flesh-colored to erythematous papules that coalesce to form centrifugally enlarging annular patterns1. However, its pathogenesis remains to be elusive. It is thought that ultraviolet radiation, heat, viral diseases or other unknown factors transform the antigenicity of elastic fibers and induce cellular immune reactions1,2. A 49-year-old Korean woman had reddish patches on the right side of her face from birth. She was diagnosed with capillary malformation about 20 years ago. She has treated the skin lesion with a pulsed dye laser (PDL) and fractional laser >10 times with 7 years. However, her skin lesion has not completely disappeared. On examination, the reddish patch had an uneven surface and firm texture (Fig. 1). These changes in the skin occurred 2 years ago. Histopathologically, there were some telangiectatic vessels and granulomatous inflammation in the superficial and mid-dermis (Fig. 2A). The dermis showed histiocytes with numerous giant cells, and some of them contained elastotic material, which was consistent with actinic granuloma (Fig. 2B, C). Because of previous repeated laser therapy, we presumed that these granulomatous reactions resulted from the laser therapy-induced actinic and/or heat damage. First, she was treated with oral methylprednisolone (8 mg; Methylon; Kunwha, Seoul, Korea) for 4 months and topical desonide (0.05%; Desowen Lotion; Galderma Pharma SA, Lausanne, Switzerland) for 1 year. However, this treatment resulted in no response. Then she was treated with oral isotretinoin (10 mg; Roaccutane; Roche, Basel, Switzerland) for 4 months, but she also had a minimal response. Fig. 1 (A) Ill-demarcated reddish patch with an (B) uneven surface and firm texture on the right side of the face (white arrow: the biopsy site). Fig. 2 (A) Some telangiectatic vessels and granulomatous inflammation in the superficial and mid-dermis (H&E, ×40). (B) The granuloma is comprised of numerous giant cells (H&E, ×200). (C) Some giant cells are contained in the ... Actinic granuloma typically affects exposed, weather-beaten skin in patients who are at least aged >30 years. Predilection sites are the neck, face, chest, and arms. O'Brien3 considered actinic granuloma to be a phenomenon of repair within damaged connective tissue. A biopsy specimen shows three distinct zones in the dermis. At the periphery within normal skin, actinic elastosis is prominent. The annulus shows a histiocytic and giant cell inflammatory reaction in the papillary and mid-dermal region. The giant cells may contain intracytoplasmic degenerated elastic fibers, or they may surround the foci of elastosis. A center, relatively elastin-free zone is present within the annulus3,4. The differential diagnosis includes granuloma annulare and necrobiosis lipoidica. The absence of dermal mucin and the presence of larger, more numerous giant cells help to distinguish actinic granuloma from granuloma annulare. The presence of elastophagocytosis, degenerated collagen, and sclerosis aid in distinguishing actinic granuloma from necrobiosis lipoidica. The treatment of actinic granuloma has been disappointing. Most reports have cited poor response to topical steroids with a single report of a response to isotretinoin5. In our current report, the patient was previously treated with PDL and fractional laser therapy >10 times. She was a housewife living in an urban area. We thought that the actinic granuloma resulted from the repeated laser therapy-induced heat and/or actinic damage. And, the damage may have destroyed the elastic fiber, which triggers an inflammatory response that causes granulomas. We describe an unusual case of actinic granuloma arising from the laser therapy treated skin.

O′Brien actinic granuloma: A case report and brief review of literature

O’Brien first described the actinic granuloma in 1975, as an infrequent granulomatous disorder occurring in sun-exposed skin, with a slow but often self-limited course. Ever since its initial description, the actinic physiopathogenic hypothesis has been debated by many authors. We report a 60-year-old female rural worker that presented with a 14 × 7 cm annular lesion with erythematous elevated borders and an atrophic center on the right calf. The lesion was evolving for 2 years, and histopathology confirmed actinic granuloma. She started acitretin with halting of disease progression after 6 months of therapy. Our case can also be associated to actinic damage, despite its unusual location, therefore highlighting the role of solar elastosis in the development of O’Brien actinic granuloma.

Clinical and morphological features of elastolytic granulomas

The authors discuss current data on the classification, etiology and pathogenesis, clinical picture, pathologic features and treatment options of elastolytic granulomas (EGs). The authors disclose main aspects of elastolysis and elastophagocytosis development. Three cases of diseases from the EG group - actinic granuloma and annular elastolytic giant cell granuloma -are described for the first time in the Russian literature.

Annular elastolytic giant cell granuloma of conjunctiva: A case report

Annular elastolytic giant cell granuloma is a condition characterized histologically by damaged elastic fibers associated with preponderance of giant cells along with absence of necrobiosis, lipid, mucin, and pallisading granuloma. It usually occurs on sun-damaged skin and hence the previous name actinic granuloma. A similar process occurs on the conjunctiva. Over the past three decades only four cases of conjunctival actinic granuloma have been documented. All the previous patients were females with lesions in nasal or temporal bulbar conjunctiva varying 2-3 mm in size. We report a male patient aged 70 years presenting with a 14 mm × 7 mm fleshy mass on right lower bulbar conjunctiva. Clinical differential diagnoses were lymphoma, squamous cell carcinoma in situ and amyloidosis. Surgical excision followed by histopathology confirmed it to be a case of actinic granuloma. This is the first case of isolated conjunctival actinic granuloma of such a large size reported from India.