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Promsena P, Triyangkulsri K, Rutnin S. Two Case Reports of Elastolytic Giant Cell Granuloma on the Palms. Clin Cosmet Investig Dermatol 2023; 16:2497-2502. [PMID: 37724128 PMCID: PMC10505374 DOI: 10.2147/ccid.s422554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
Elastolytic giant cell granuloma (EGCG) is a rare granulomatous reaction hypothesized to occur because of the altered antigenicity of elastic fibers, resulting in cellular immunological reactions. The hallmarks of EGCG include elastolysis, elastophagocytosis, and multinucleated giant cell infiltrations. EGCG was first described as an actinic granuloma or annular elastolytic giant cell granuloma that classically presents as centrifugally expanding annular plaques on sun-exposed areas. It was recently named EGCG due to reports of non-annular lesions in various sun-protected areas. Hand involvement has been described but is almost exclusively confined to the dorsal and lateral aspects of the hands. Herein, we report two cases of EGCG on the palms, an unusual site of presentation, that were successfully treated with topical, high-potency corticosteroids. EGCG should be included in the differential diagnosis in cases of annular skin lesions located on the marginal area of the palms.
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Affiliation(s)
- Pichamon Promsena
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Korn Triyangkulsri
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthinee Rutnin
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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2
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Kansara KG, Pawar PM, Dharmender J, Patel J, Joshi RR. A Ringed Enigma: A Case of Annular Elastolytic Giant Cell Granuloma Successfully Treated with Hydroxychloroquine. Indian Dermatol Online J 2023; 14:721-722. [PMID: 37727577 PMCID: PMC10506799 DOI: 10.4103/idoj.idoj_589_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/16/2022] [Accepted: 02/12/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Kajal G. Kansara
- Department of Skin and V.D, Civil Hospital, B J Medical College, Ahmedabad, Gujarat, India
| | - Priyanka M. Pawar
- Department of Skin and V.D, Civil Hospital, B J Medical College, Ahmedabad, Gujarat, India
| | - J Dharmender
- Department of Skin and V.D, Civil Hospital, B J Medical College, Ahmedabad, Gujarat, India
| | - Jigna Patel
- Department of Skin and V.D, Civil Hospital, B J Medical College, Ahmedabad, Gujarat, India
| | - Rima R. Joshi
- Department of Skin and V.D, Civil Hospital, B J Medical College, Ahmedabad, Gujarat, India
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3
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Ahlers C, Parker ER. A report of disseminated actinic granuloma: An unusually extensive presentation. SAGE Open Med Case Rep 2023; 11:2050313X231195487. [PMID: 37654549 PMCID: PMC10467196 DOI: 10.1177/2050313x231195487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
In this report, a case of disseminated actinic granuloma in a 50-year-old female with type 2 diabetes mellitus is described. This case is unique due to the unusually extensive cutaneous involvement of the face, neck, trunk, and extremities at initial presentation. The lesions were in a striking photo-distribution, highlighting ultraviolet light as an important environmental trigger for this process. Interestingly, the patient refused the recommended systemic therapy with hydroxychloroquine, despite her significant burden of skin disease. This refusal stems from an unexpected reluctance on the part of the patient to take this medication due to the publicity and media coverage of side effects associated with inappropriate prescribing of this drug during the COVID-19 pandemic, presenting a new and surprising treatment barrier that clinicians may need to overcome.
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Affiliation(s)
- Carolyn Ahlers
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Eva Rawlings Parker
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
- School of Medicine, Vanderbilt University, Nashville, TN, USA
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4
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Qian YT, Liu JW, Liu W, Chen T, Tan Y, Ma DL. A Retrospective Study of 105 Patients with Elastolytic Giant Cell Granuloma and a Proposal for a New Clinical Classification. Acta Derm Venereol 2022; 102:adv00684. [PMID: 35170741 PMCID: PMC9574680 DOI: 10.2340/actadv.v102.1985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Dong-Lai Ma
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, No.1, Shuaifuyuan, Dongcheng District, Beijing 100730, China.
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5
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Burlando M, Herzum A, Cozzani E, Paudice M, Parodi A. Can Methotrexate be a successful treatment for unresponsive generalized annular elastolytic giant cell granuloma? Case report and review of the literature. Dermatol Ther 2020; 34:e14705. [PMID: 33369018 DOI: 10.1111/dth.14705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/06/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disorder, characterized by erythematous plaques with elevated borders and hypopigmented center, occurring mainly on sun exposed-skin. Histologically it presents with elastophagocytosis and elastolysis. There is no established first line treatment for AEGCG, especially for the generalized form. In a small number of cases, antimalarial drugs and tranilast, associated to topical or oral steroids, have been proposed to treat generalized AEGCG with partial benefits. We herein present the case of a patient with AEGCG aged 74 years, who was unresponsive to classical therapies, and then successfully treated with methotrexate.
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Affiliation(s)
- Martina Burlando
- DISSAL Department of Dermatology, University of Genova Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Astrid Herzum
- DISSAL Department of Dermatology, University of Genova Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Emanuele Cozzani
- DISSAL Department of Dermatology, University of Genova Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Michele Paudice
- Department of Surgical and Diagnostic Sciences, University of Genova, Anatomic Pathology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Aurora Parodi
- DISSAL Department of Dermatology, University of Genova Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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6
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Reverse Isotopic Phenomenon in Drug Reaction with Eosinophilia and Systemic Symptoms. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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7
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Adil M, Amin SS, Dinesh Raj R, Tabassum H. Reverse Isotopic Phenomenon in Drug Reaction with Eosinophilia and Systemic Symptoms. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:613-615. [PMID: 30236950 DOI: 10.1016/j.ad.2018.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/26/2017] [Accepted: 02/11/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- M Adil
- Departamento de Dermatología, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
| | - Syed Suhail Amin
- Departamento de Dermatología, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - R Dinesh Raj
- Departamento de Dermatología, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Hera Tabassum
- Departamento de Dermatología, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
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8
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Margerin F, Cribier B. Granulome annulaire élastolytique à cellules géantes : étude anatomoclinique. Ann Dermatol Venereol 2017; 144:589-598. [DOI: 10.1016/j.annder.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/13/2017] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
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9
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Chen WT, Hsiao PF, Wu YH. Spectrum and clinical variants of giant cell elastolytic granuloma. Int J Dermatol 2017; 56:738-745. [DOI: 10.1111/ijd.13502] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/11/2016] [Accepted: 09/20/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Wan-Ting Chen
- Department of Dermatology; Mackay Memorial Hospital; Taipei Taiwan
| | - Pa-Fan Hsiao
- Department of Dermatology; Mackay Memorial Hospital; Taipei Taiwan
- Department of Medicine; Mackay Medical College; New Taipei City Taiwan
- Department of Cosmetic Applications and Management; Mackay Junior College of Medicine, Nursing, and Management; Taipei Taiwan
| | - Yu-Hung Wu
- Department of Dermatology; Mackay Memorial Hospital; Taipei Taiwan
- Department of Medicine; Mackay Medical College; New Taipei City Taiwan
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10
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Thacker PM, Nayak K, Lobo FD, Govindasamy P. O'Brien's Granuloma- A Case Report. J Clin Diagn Res 2016; 10:WD05-WD06. [PMID: 27891439 DOI: 10.7860/jcdr/2016/22772.8675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/29/2016] [Indexed: 11/24/2022]
Abstract
Actinic granuloma is a self-limiting chronic disorder with elastolytic granulomas, mainly of the sun exposed skin and unknown pathogenesis. We report a case of a middle aged woman with multiple annular erythematous lesions. Histopathology revealed degenerated elastic fibres with histiocyte aggregates surrounded by multiple giant cells suggestive of elastolytic granulomas. She also had associated dyslipidemia and hypothyroidism. Actinic granuloma is relatively rare in the Indian population and needs to be differentiated from conditions like sarcoidosis and granuloma annulare.
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Affiliation(s)
- Pratik Mukesh Thacker
- Resident, Department of Dermatology, Kasturba Medical College , Mangaluru, Karnataka, India
| | - Kashinath Nayak
- Associate Professor, Department of Dermatology, Kasturba Medical College , Mangaluru, Karnataka, India
| | - Flora Dorothy Lobo
- Professor, Department of Pathology, Kasturba Medical College , Mangaluru, Karnataka, India
| | - Pavithra Govindasamy
- Resident, Department of Dermatology, Kasturba Medical College , Mangaluru, Karnataka, India
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11
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Pham AK, Dinulos JG, Quinn TR. Annular elastolytic giant cell granuloma after a cardiac pacemaker implantation. JAAD Case Rep 2016; 2:357-9. [PMID: 27622209 PMCID: PMC5007655 DOI: 10.1016/j.jdcr.2016.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Anh Khoa Pham
- Section of Dermatology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - James G Dinulos
- University of Connecticut, Farmington, Connecticut; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Seacoast Dermatology, Portsmouth, New Hampshire
| | - Timothy R Quinn
- Dermpath Diagnostics New England, Marlborough, Massachusetts
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12
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Caccavale S, Kannangara AP, Ruocco E. Categorization of and comments on isomorphic and isotopic skin reactions. Clin Dermatol 2015; 35:105-110. [PMID: 27938807 DOI: 10.1016/j.clindermatol.2015.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Locus minoris resistentiae (lmr) can be defined as a site of the body that offers lesser resistance than the rest of the body to the onset of disease. The well-known Köbner phenomenon is itself a clear example of lmr in dermatology. The new term locus maioris resistentiae (LMR), a site of the body that offers greater resistance than the rest of the body to the onset of disease, defines the opposite condition. Renbök phenomenon (reverse Köbner's isomorphic response) typically represents an example of LMR.
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Affiliation(s)
- Stefano Caccavale
- Department of Dermatology, Second University of Naples, Naples, Italy.
| | | | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
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13
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Gutiérrez-González E, Pereiro M, Toribio J. Elastolytic Actinic Giant Cell Granuloma. Dermatol Clin 2015; 33:331-41. [DOI: 10.1016/j.det.2015.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Ruocco V, Ruocco E, Piccolo V, Brunetti G, Guerrera LP, Wolf R. The immunocompromised district in dermatology: A unifying pathogenic view of the regional immune dysregulation. Clin Dermatol 2015; 32:569-76. [PMID: 25160098 DOI: 10.1016/j.clindermatol.2014.04.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Besides the systemic immune deficiency, a sectorial default in immune control may occur in immunocompetent subjects. This regional immune defect can appear and remain confined to differently damaged skin areas, lately labeled immunocompromised districts (ICDs). An ICD is a skin area more vulnerable than the rest of the body for genetic or acquired reasons. Its vulnerability mainly consists in a local dysregulation of the immune control, which often facilitates (but sometimes hinders) the local onset of immunity-related eruptions or skin disorders. The factors responsible for localized immune dysregulation are multifarious, being represented by chronic lymphatic stasis, herpetic infections, ionizing or ultraviolet (UV) radiations, burns, all sorts of trauma (especially amputation), tattooing, intradermal vaccinations, and others of disparate nature (eg, paralytic stroke, poliomyelitis). Whatever the cause, in time an ICD may become a vulnerable site, prone to developing opportunistic infections, tumors, or dysimmune reactions (often of granulomatous type), strictly confined to the district itself; however, the opposite may also occur with systemic immune disorders or malignancies that selectively spare the district. In any case, the immunologic behavior of an ICD is different from that of the rest of the body. The pathomechanisms involved in this sectorial immune destabilization may reside in locally hampered lymph drainage that hinders the normal trafficking of immunocompetent cells (eg, chronic lymphedema, posttraumatic lymph stasis) or in a damage to sensory nerve fibers that release immunity-related peptides (eg, herpetic infections, carpal tunnel syndrome), or in both conditions (eg, amputation stump, radiation dermatitis). The ICD is a conceptual entity with no definite shape or dimension. It may take an extremely variable form and extent depending on the causative agent, ranging from a minimal area (eg, intradermal vaccination) or a small area (eg, herpes simplex infection), through a wide area (eg, radiotherapy), a bandlike segment (eg, skin mosaicism, herpes zoster infection), or an acral area (eg, carpal tunnel syndrome), up to a whole limb (eg, Stewart-Treves syndrome) or even an entire half body (eg, brain stroke). Varied newly coined terminology can be used to indicate the specific cause each time that it is responsible for a regional immune dysregulation. The advantage of the umbrella term ICD is that it encompasses all the possible causes involved in a local immune destabilization. An ICD may have a congenital or a postnatal origin, and interesting similarities between the two forms exist. An ICD may also take place in patients with a preexisting systemic immune deficiency, thus creating a more vulnerable site in an already vulnerable patient. Identifying a cutaneous ICD in a given patient is an important standpoint for both diagnostic and prevention purposes. This can be proven by the educative clinical examples that are reported here.
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Affiliation(s)
- Vincenzo Ruocco
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy.
| | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Vincenzo Piccolo
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Giampiero Brunetti
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Luigi Pio Guerrera
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Ronni Wolf
- Dermatology Unit, Kaplan Medical Center, Rehovot, Israel. Affiliated to The School of Medicine, Hebrew University and Hadassah, Jerusalem
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Konar K, Sanyal S, Rakshit A. Annular elastolytic giant cell granuloma of conjunctiva: a case report. Indian J Ophthalmol 2015; 62:361-3. [PMID: 24722274 PMCID: PMC4061685 DOI: 10.4103/0301-4738.121142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Karabi Konar
- Department of Pathology, Burdwan Medical College, Burdwan, West Bengal, India
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16
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Patrushev AV, Khairutdinov VR, Belousova IE, Samtsov AV. Clinical and morphological features of elastolytic granulomas. VESTNIK DERMATOLOGII I VENEROLOGII 2014. [DOI: 10.25208/0042-4609-2014-90-4-58-67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
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.
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Basak PY, Icke I, Akkaya VB, Basak K. Lack of Response to Isotretinoin in Annular Elastolytic Giant Cell Granuloma. J Dermatol 2014; 31:678-81. [PMID: 15492443 DOI: 10.1111/j.1346-8138.2004.tb00576.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Accepted: 03/30/2004] [Indexed: 11/26/2022]
Abstract
Annular elastolytic giant cell granuloma is a rare disease characterized by annular configurated lesions with typical histopathologic findings. We report a case of annular elastolytic giant cell granuloma in a 50-year-old male patient. Treatment modalities for this disease are limited and mostly unsatisfactory, although isotretinoin was found to be effective in a single case. However, systemic isotretinoin treatment of 12 weeks' duration was of no benefit in the presented case.
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Affiliation(s)
- Pinar Y Basak
- Süleyman Demirel University Faculty of Medicine Department of Dermatology, Isparta, Turkey
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18
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Pinal-Fernandez I, Solans-Laqué R. The ‘Sparing Phenomenon' of Purpuric Rash over Tattooed Skin. Dermatology 2013; 228:27-30. [DOI: 10.1159/000356779] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/18/2013] [Indexed: 11/19/2022] Open
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Hybrid Clinical and Histopathological Pattern in Annular Lesions: An Overlap between Annular Elastolytic Giant Cell Granuloma and Granuloma Annulare? Case Rep Dermatol Med 2012; 2012:102915. [PMID: 23259076 PMCID: PMC3505946 DOI: 10.1155/2012/102915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/23/2012] [Indexed: 11/18/2022] Open
Abstract
Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disease of unclear pathogenesis which belongs to the group of disorders in the skin and elastic fibers with similar clinical features of granuloma annulare (GA). This case report is intended to describe a rare hybrid pattern in histopathology demonstrating coexistence of AEGCG and GA. An endocrine disease, such as diabetes mellitus (DM), could contribute to the coexistence of both lesions, and this possibility must be included in the medical investigation.
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20
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OKA M, KUNISADA M, NISHIGORI C. Generalized annular elastolytic giant cell granuloma with sparing of striae distensae. J Dermatol 2012; 40:220-2. [DOI: 10.1111/1346-8138.12048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Masahiro OKA
- Division of Dermatology; Department of Internal Related; Kobe University Graduate School of Medicine; Kobe; Japan
| | - Makoto KUNISADA
- Division of Dermatology; Department of Internal Related; Kobe University Graduate School of Medicine; Kobe; Japan
| | - Chikako NISHIGORI
- Division of Dermatology; Department of Internal Related; Kobe University Graduate School of Medicine; Kobe; Japan
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22
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Can B, Kavala M, Türkoğlu Z, Zindancı İ, Topaloğlu F, Zemheri E. Successful treatment of annular elastolytic giant cell granuloma with hydroxychloroquine. Int J Dermatol 2012; 52:509-11. [DOI: 10.1111/j.1365-4632.2011.04941.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Shoimer I, Wismer J. Annular Elastolytic Giant Cell Granuloma Associated with Temporal Arteritis Leading to Blindness. J Cutan Med Surg 2011; 15:293-7. [DOI: 10.2310/7750.2011.10042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous disorder characterized by giant cells in the dermis phagocytosing damaged elastin fragments. Objective: We report a case of a 71-year-old man presenting with erythematous plaques in predominantly sun-exposed areas. Method: A diagnosis of AEGCG was made based on the clinical and histologic picture, and treatment with systemic steroids was initiated. However, while tapering the steroid dose, the patient developed a radiating headache that progressed to temporal arteritis and eventual blindness in the right eye. Conclusion: There have been only two previous case reports presenting an association between AEGCG and temporal arteritis. This report explores AEGCG and its possible relationship to temporal arteritis along with possible treatment regimens cited in the current literature.
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Affiliation(s)
- Ilya Shoimer
- From the Department of Dermatology, McMaster University, Hamilton, ON
| | - Judy Wismer
- From the Department of Dermatology, McMaster University, Hamilton, ON
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Gonçalves RRDV, Miranda MFRD, Viana FDO, Cavaleiro LHDS, Fonseca DMD. Granuloma anular elastolítico gigantocelular: relato de caso. An Bras Dermatol 2011; 86:S69-71. [DOI: 10.1590/s0365-05962011000700017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 12/28/2010] [Indexed: 11/22/2022] Open
Abstract
O granuloma anular elastolítico gigantocelular é dermatose granulomatosa rara, caracterizada, histologicamente, por fagocitose das fibras elásticas por células gigantes multinucleadas e, clinicamente, por placas anulares com bordas elevadas e centro atrófico, com preferência por áreas expostas. A patogênese é controversa. Descreve-se um caso de mulher de 44 anos, com achados clínicos e histológicos clássicos, que apresentou boa resposta à hidroxicloroquina, após o período de 1 mês
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Aso Y, Izaki S, Teraki Y. Annular elastolytic giant cell granuloma associated with diabetes mellitus: a case report and review of the Japanese literature. Clin Exp Dermatol 2011; 36:917-9. [DOI: 10.1111/j.1365-2230.2011.04094.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Djilali-Bouzina F, Grange F, Krzisch S, Schnebelen MP, Grosshans E, Guillaume JC. [Annular elastolytic giant cell granuloma]. Ann Dermatol Venereol 2010; 137:536-40. [PMID: 20804898 DOI: 10.1016/j.annder.2010.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 04/16/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Annular elastolytic giant cell granuloma (AEGCG) is a rare form of granulomatous dermatosis. It is characterised histologically by phagocytosis of elastic fibres by multinucleated cells. We report a favourable outcome in a case of AEGCG following PUVA therapy and treatment with synthetic antimalarials. PATIENTS AND METHODS A 67-year-old retired wine grower presented with highly pruritic annular lesions with raised borders on the shoulders and trunk that had been present for several months. Histological examination of a biopsy sample from the erythematous border was characteristic of AEGCG. Various topical treatments proved ineffective and systemic corticosteroids attenuated the patient's pruritus but had no effect on the skin lesions. PUVA therapy resulted in regression of lesions on the trunk, but the rash spread to the patient's arms and was covered with epidermal microcysts. PUVA therapy was discontinued and treatment with a synthetic antimalarial (hydroxychloroquine 400mg/d) was initiated, resulting in complete regression of the lesions. DISCUSSION AEGC was isolated in 1979 by Hanke et al. on the basis of five cases seen in females. This is a rare form of dermatosis with some 30 cases being reported in the English literature. The clinical aspect is fairly evocative, with erythematous papular lesions, either alone or in groups, with a raised border and a lighter centre tending towards atrophy. In most cases, the lesions are found predominantly in areas exposed to sunlight. The histological appearance is characteristic, with an image of giant cell elastophagic granuloma from which the name of the disease is taken. This appearance allows the disease to be differentiated from a number of other granulomatous diseases. The aetiology is unknown and treatment is empirical. Spontaneous cure can occur and consistent results have not been obtained with any treatments. In our case, PUVA was partly successful, and the synthetic antimalarials resulted in complete regression of residual lesions.
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Granulome annulaire élastolytique à cellules géantes. Ann Dermatol Venereol 2010; 137:532-5. [DOI: 10.1016/j.annder.2009.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Accepted: 04/17/2009] [Indexed: 11/21/2022]
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Actinic granuloma affecting the upper lip: a rare and challenging clinical entity. Br J Oral Maxillofac Surg 2010; 48:234-5. [DOI: 10.1016/j.bjoms.2009.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Accepted: 08/23/2009] [Indexed: 10/20/2022]
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Campos-Muñoz L, Díaz-Díaz RM, Quesada-Cortés A, Hernández-Cano N, Martín-Díaz MA, Regojo-Zapata RM, Casado Jiménez M. [Annular elastolytic giant cell granuloma: a case report located in non-sun exposed areas]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:533-5. [PMID: 17067534 DOI: 10.1016/s0001-7310(06)73458-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Annular elastolytic giant cell granuloma (AEGCG) is an uncommon entity clinically characterized by erythematous annular plaques with atrophic and hypopigmented center, that predominates in sun-exposed zones. The histology shows a granulomatous infiltrate without palisading image, made up of lymphocytes, histiocytes and giant cells, with phagocytosis of elastic fibers, without necrobiosis or mucin deposit. We present the case of a male patient with atypical clinical manifestation on the non-sun exposed skin and AEGCG characteristic histology.
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Affiliation(s)
- Lucía Campos-Muñoz
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España.
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Takata T, Ikeda M, Kodama H, Ohkuma S. Regression of Papular Elastolytic Giant Cell Granuloma Using Narrow-Band UVB Irradiation. Dermatology 2006; 212:77-9. [PMID: 16319480 DOI: 10.1159/000089028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 07/22/2005] [Indexed: 11/19/2022] Open
Abstract
A 71-year-old Japanese man presented with asymptomatic, firm, brown-red papules on the dorsum of his left hand and back. A biopsy specimen revealed granulomatous infiltration consisting of multinucleated giant cells and histiocytes in the upper dermis. Elastic fibers were absent in the upper dermis, having been phagocytosed by giant cells. These papular elastolytic giant cell granuloma lesions regressed very well with narrow-band ul traviolet B irradiation, with only residual brown pigmentation left after treatment.
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Affiliation(s)
- T Takata
- Department of Dermatology, Kochi Medical School, Kochi University, Kochi, Japan.
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Hinrichs R, Weiss T, Peschke E, Scharffetter-Kochanek K, Weber L. A reticular variant of elastolytic giant cell granuloma. Clin Exp Dermatol 2006; 31:42-4. [PMID: 16309478 DOI: 10.1111/j.1365-2230.2005.01926.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An 80-year-old man presented with a distinctive reticular form of elastolytic giant cell granuloma (EGCG). This represents a rare subset of EGCG, thus belonging to a larger group of granulomatous skin diseases with poorly understood pathogenesis. The patient exhibited numerous erythematous to brownish, sharply demarcated patches of reticulate appearance with partial central atrophy and nonelevated margins, which involved the trunk and especially chest, shoulders, upper back and arms. Skin biopsy revealed a granulomatous infiltrate with multinucleate histiocytes containing remnants of elastic fibres in conjunction with a significant loss of elastic fibres throughout the dermis. There is little published information on treatment, which remains unsatisfactory.
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Affiliation(s)
- R Hinrichs
- Department of Dermatology and Allergology, University of Ulm, Germany
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Lee HW, Lee MW, Choi JH, Moon KC, Koh JK. Annular elastolytic giant cell granuloma in an infant: Improvement after treatment with oral tranilast and topical pimecrolimus. J Am Acad Dermatol 2005; 53:S244-6. [PMID: 16227100 DOI: 10.1016/j.jaad.2005.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Revised: 02/03/2005] [Accepted: 02/03/2005] [Indexed: 10/25/2022]
Abstract
Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disease of unknown origin that is characterized clinically by annular patches with erythematous borders and hypopigmented centers and histologically by loss of elastic fibers and elastophagocytosis. We report a case of AEGCG in an 8-month-old boy that was successfully treated with oral tranilast and topical pimecrolimus (Elidel 1.0% cream).
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Affiliation(s)
- Hae-Woong Lee
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Breuer K, Gutzmer R, Völker B, Kapp A, Werfel T. Therapy of noninfectious granulomatous skin diseases with fumaric acid esters. Br J Dermatol 2005; 152:1290-5. [PMID: 15948995 DOI: 10.1111/j.1365-2133.2005.06585.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Noninfectious granulomatous skin diseases are inflammatory disorders of unknown aetiology which are often recalcitrant to common anti-inflammatory treatment regimens. Recently, in several case reports, fumaric acid esters (FAE) have proved beneficial in granulomatous skin diseases, but studies on a larger collection of consecutive patients have not yet been performed. OBJECTIVES To investigate the therapeutic efficacy of FAE for the treatment of granulomatous skin diseases. PATIENTS AND METHODS The therapeutic efficacy and side-effects of FAE were analysed retrospectively in 32 patients with disseminated granuloma annulare (n = 13), annular elastolytic giant cell granuloma (n = 3), sarcoidosis (n = 11), necrobiosis lipoidica (n = 4), or granulomatous cheilitis (n = 1). RESULTS Three patients discontinued treatment within 4 weeks because of side-effects. Of the remaining 29 patients, 18 patients responded to treatment with FAE. Marked improvement or complete clearance was seen in seven patients. We observed a slight to moderate improvement in 11 patients, and 11 patients did not respond. In patients showing a complete remission, the maximum effect was observed after 8.5 months (SD +/-6 months, range 3-20 months). In two patients with systemic sarcoidosis, the pulmonary changes improved in parallel with the skin. Side-effects were usually mild and resolved spontaneously upon dose reduction or discontinuation of the therapy. CONCLUSIONS The data presented here indicate that FAE may be considered for the treatment of recalcitrant granulomatous skin disease.
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Affiliation(s)
- K Breuer
- Department of Dermatology and Allergology, Hannover Medical University, Ricklinger Strasse 5, 30449 Hannover, Germany.
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Stefanaki C, Panagiotopoulos A, Kostakis P, Stefanaki K, Petridis A. Actinic granuloma successfully treated with acitretin. Int J Dermatol 2005; 44:163-6. [PMID: 15689220 DOI: 10.1111/j.1365-4632.2005.02043.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Actinic granuloma is a rare skin disorder that develops in an area of actinic elastosis. The pathogenesis of the disease is obscure but the most accepted hypothesis implicates the solar radiation as the triggering factor. Typically the disease presents in middle-aged individuals with significant past sun-exposure and involves mainly the sun-exposed skin. It manifests as asymptomatic annular patches with elevated borders and central atrophy and shows little tendency to regression. Several treatments have been tried with variable success. We present a 74-year-old male who consulted our department for annular atrophic plaques involving his forehead and nose, present for 8 months and insidiously spreading but otherwise asymptomatic. A biopsy confirmed the clinical suspicion of actinic granuloma and excluded other possibilities. Our patient was commenced on acitretin 25 mg/day and showed a remarkable improvement within a year; the lesions stopped spreading and almost disappeared.
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Affiliation(s)
- C Stefanaki
- Third Department, Andreas Sygros Skin Hospital, Athens, Greece.
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Kelly BJ, Mrstik ME, Ramos-Caro FA, Iczkowski KA. Papular elastolytic giant cell granuloma responding to hydroxychloroquine and quinacrine. Int J Dermatol 2004; 43:964-6. [PMID: 15569034 DOI: 10.1111/j.1365-4632.2004.01735.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Benjamin J Kelly
- Division of Dermatology and Cutaneous Surgery, the Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Malcolm Randall Veterans Administration Medical Center, Gainesville, FL 32610-0277, USA
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Stefanaki C, Panagiotopoulos A, Kostakis P, Stefanaki K, Petridis A. Actinic granuloma successfully treated with acitretin. Int J Dermatol 2004. [DOI: 10.1111/j.1365-4632.2004.02043.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Limas C. The spectrum of primary cutaneous elastolytic granulomas and their distinction from granuloma annulare: a clinicopathological analysis. Histopathology 2004; 44:277-82. [PMID: 14987232 DOI: 10.1111/j.0309-0167.2004.01755.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Actinic granuloma (AG) and annular elastolytic giant cell granuloma (AEGCG) are terms commonly applied to cutaneous lesions characterized by elastolysis, elastophagocytosis and a multinucleated cell infiltrate. The aim of this study was to clarify the relationship of these lesions to granuloma annulare (GA) which they resemble clinically. METHODS AND RESULTS The clinicopathological data of 20 patients whose biopsies showed the histology of elastolytic granuloma as well as those of previously published cases with identical tissue changes were analysed to assess differences between AG, AEGCG and GA. The tissue changes of AG and AEGCG are identical and differ substantially from GA because of the predominant elastolysis and elastophagocytosis in the absence of necrobiosis and palisading granuloma. Actinic and/or thermal injury could be elicited frequently in the patient's history, but not always. CONCLUSIONS AG may be considered as an aetiopathological subdivision of AEGCG. Patients with biopsies showing both GA and AEGCG are occasionally encountered. AEGCG is easily differentiated from incidental elastolysis which may be seen in a variety of aetiologically unrelated processes.
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Affiliation(s)
- C Limas
- Department of Dermatopathology, Andreas Sygros Hospital, Athens, Greece
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Doulaveri G, Tsagroni E, Giannadaki M, Bosemberg E, Limas C, Potouridou I, Zakopoulou N. Annular elastolytic giant cell granuloma in a 70-year-old woman. Int J Dermatol 2003; 42:290-1. [PMID: 12694495 DOI: 10.1046/j.1365-4362.2003.01767.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wozniacka A, Carter A, McCauliffe DP. Antimalarials in cutaneous lupus erythematosus: mechanisms of therapeutic benefit. Lupus 2002; 11:71-81. [PMID: 11958581 DOI: 10.1191/0961203302lu147rr] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antimalarials are arguably the best modality currently available for treating patients with cutaneous lupus erythematosus (LE). Although antimalarials have been used for decades in treating cutaneous LE, the precise mechanisms by which they provide therapeutic benefit are not well defined. The putative mechanisms by which antimalarials might provide therapeutic benefit to patients with cutaneous LE include a number of interrelated anti-inflammatory and immunosuppressive effects that include photoprotection, lysosomal stabilization, suppression of antigen presentation, and inhibition of prostaglandin and cytokine synthesis. If we had a more precise understanding of how antimalarials provide therapeutic benefit in cutaneous LE we might gain better insight into the pathogenic mechanisms of LE and ways of developing better therapies for afflicted patients.
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Affiliation(s)
- A Wozniacka
- Department of Dermatology, Medical University of Lodz, Krzemieniecka, Poland
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Biancone L, Geboes K, Spagnoli LG, Del Vecchio Blanco G, Monteleone I, Vavassori P, Palmieri G, Chimenti S, Pallone F. Metastatic Crohn's disease of the forehead. Inflamm Bowel Dis 2002; 8:101-5. [PMID: 11854608 DOI: 10.1097/00054725-200203000-00006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Metastatic Crohn's disease (CD) involves the presence of cutaneous granuloma distant from the intestinal lesions related to the disease, usually observed in colonic CD. CASE HISTORY A 35-year-old female with a permanent ileostomy following proctocolectomy for CD presented in 1999 with a 2-month history of an unusual skin lesion of the forehead. A diagnosis of CD of the ileum, colon, and rectum had been made in 1994. In 1997, a proctocolectomy with ileostomy was performed due to fistulizing severe refractory disease. Microscopic aspects of the intestinal lesions showed deep and fissuring ulcers. After surgery, she went into remission, and a small bowel follow-up in 1999 showed no recurrence, when she presented with the skin lesion of the forehead. MICROSCOPIC DATA: Histological analysis of endoscopical and surgical intestinal specimens showed chronic granulomatous inflammation of the ileum, colon, and rectum, confirming the diagnosis of CD. The forehead skin biopsy was examined by three independent histopathologists. The lesion was composed of numerous small granulomas (Ziehl-Nielsen negative), with no foreign bodies, mainly composed of CD68-positive and periodic acid Schiff-negative monocytes. Despite the low number of lymphocytes, the macroscopical and microscopical aspect of the forehead lesion, together with the clinical history, led to a diagnosis of rare metastatic CD of the forehead. CONCLUSIONS This case report describes the development of an unusual granulomatous skin lesion of the forehead in a patient with established CD showing no postoperative recurrence.
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Affiliation(s)
- Livia Biancone
- Department of Internal Medicine, Units of Gastroenterology and Dermatology, and Department of Pathology, University of Rome Tor Vergata, Via di Tor Vergata 135, 00133 Rome, Italy.
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