Actinic Granuloma: The Expanding Significance

Annular Elastolytic Giant Cell Granuloma

Annular elastolytic giant cell granuloma (AEGCG) is a rare, often self-limiting chronic inflammatory disorder mostly occurring in the sun-exposed areas such as the dorsum of hands, extensor surfaces of arms, face, anterior neck, and upper chest. The pathognomonic histological findings include the presence of numerous granulomas associated with loss of elastic fibers that appear to be ingested by multi-nucleated giant cells. Here, we present a case of a 56-year-old woman with multiple, anatomically variable erythematous lesions- annular and papular, mainly in the upper body. The clinical presentation and histopathologic findings support our diagnosis.

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.

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.

Hypertrophic lupus erythematosus: a clinicopathological study of 14 cases

BACKGROUND

Hypertrophic lupus erythematosus (HLE) is a distinct and rare subset of lupus erythematosus (LE). It is characterized by verrucous lesions, chronic in its course, and resistant to treatment. The purpose of this study was to identify clinical and histological characteristics of HLE.

METHODS

We review our experience with 14 cases of HLE identified in a group of 220 patients with different forms of LE, at the UNICAMP Hospital, between 1976 and 2002.

RESULTS

All patients presented verrucous plaques concomitantly with discoid lesions. The most common sites of involvement were the face and the arms. Histology of HLE lesions revealed pseudoepitheliomatous hyperplasia engulfing elastotic material. Elastic fibers were seen in migration throughout the epidermis. Classic features of LE were noted in all cases. Three of the patients developed hyperkeratotic papules with central keratinous plug on their arms at the previous LE sites. These lesions resemble clinically and histopathologically keratoacanthomas. In one patient, HLE lesion progressed to squamous cell carcinoma (SCC), 26 years after the onset of the disease.

CONCLUSIONS

Transepithelial elimination of the elastotic material may be a feature of HLE. Some HLE lesions may present as keratoacanthoma, but classical features of LE aid the correct diagnosis. SCC may arise on a long-standing HLE lesion; therefore HLE requires clinical and histopathological follow up.

Intrinsic aging vs. photoaging: a comparative histopathological, immunohistochemical, and ultrastructural study of skin

Cutaneous aging is a complex biological phenomenon affecting the different constituents of the skin. To compare the effects of intrinsic and extrinsic aging processes, a total of 83 biopsies were collected from sun-exposed and protected skin of healthy volunteers representing decades from the 1st to the 9th (6-84 years of age). Routine histopathology coupled with computer-assisted image analysis was used to assess epidermal changes. Immunoperoxidase techniques with antibodies against type I and type III collagens and elastin were used to quantitatively evaluate changes in collagen and elastic fibers and their ultrastructure was examined by transmission electron microscopy. Epidermal thickness was found to be constant in different decades in both sun-exposed and protected skin; however, it was significantly greater in sun-exposed skin (P = 0.0001). In protected skin, type I and III collagen staining was altered only after the 8th decade, while in sun-exposed skin the relative staining intensity significantly decreased from 82.5% and 80.4% in the 1st decade to 53.2% and 44.1% in the 9th decade, respectively (P = 0.0004 and 0.0008). In facial skin the collagen fiber architecture appeared disorganized after the 4th decade. The staining intensity of elastin in protected skin significantly decreased from 49.2% in the 1st decade to 30.4% in the 9th decade (P = 0.05), whereas in sun-exposed skin the intensity gradually increased from 56.5% in the 1st decade to 75.2% in the 9th decade (P = 0.001). The accumulated elastin in facial skin was morphologically abnormal and appeared to occupy the areas of lost collagen. Collectively, the aging processes, whether intrinsic or extrinsic, have both quantitative and qualitative effects on collagen and elastic fibers in the skin.

Actinic granuloma is a unique and distinct entity: a comparative study with granuloma annulare

Since the initial description of actinic granuloma (AG), debate has continued over whether it should be considered a specific condition or simply granuloma annulare (GA) located in sun-exposed areas of skin. We conducted a case-control study to clarify this issue. Twenty cases given the diagnosis of AG between 1991 and 2001 were retrieved from our archives. We applied the following inclusion criteria: extensive loss of elastic tissue in or at the side of the granuloma, and elastophagocytosis. Sixteen cases of GA that involved sun-exposed and non-sun-exposed sites, 8 cases from each group, were randomly selected as controls. Histologic parameters were quantitated on hematoxylin-eosin, Verhoeff van Gieson, and Alcian blue stains for each case. Results were statistically analyzed by SPSS program version 9. Fourteen cases of AG met our inclusion criteria. Presence of mucin, occurrence of multinucleated giant cells, and the type of granulomata were of high statistical significance (p < 0.01) in distinguishing the two entities. We also found that the location of the granulomata in these conditions is different and of statistical significance (p < 0.05). Based on histomorphology, we believe that AG should be considered a separate, independent condition and should be distinguished from GA even in sun-exposed areas of skin.