Actinic granuloma | |
---|---|
Other names | O'Brien granuloma |
Specialty | Dermatology |
Causes | Inflammatory response to sun damage and possibly to injured elastic fibers. [1] |
Diagnostic method | Skin biopsy. [1] |
Differential diagnosis | Granuloma annulare and necrobiosis lipoidica. [1] |
Prevention | Sun protection. [1] |
Actinic granuloma (AG) was first described by O'Brien in 1975 as a rare granulomatous disease. [2] Lesions appear on sun-exposed areas, usually on the face, neck, and scalp, with a slight preference for middle-aged women. They are typically asymptomatic, single or multiple, annular or polycyclic lesions measuring up to 6 cm in diameter, with slow centrifugal expansion, an erythematous elevated edge, and a hypopigmented, atrophic center. [3]
The granulomatous inflammation is thought to be caused by a cell-mediated autoimmune response against damaged elastic fibers. When actinic granuloma-like lesions appear in non-exposed areas, the rash is known as annular elastolytic giant cell granuloma. Though these can be easily distinguished based on histopathologic features and laboratory findings, the differential diagnosis includes tinea corporis, sarcoidosis, subacute lupus erythematosus, granuloma annulare, and other infectious granulomatous diseases. Chloroquine, intralesional or systemic steroids, cyclosporine, isotretinoin, acitretin, and laser treatment have all been tried with varying degrees of success. [4]
The lesions, which primarily affect sun-exposed areas such as the face, neck, chest, and upper arms, begin as red or skin-colored papules and progress insidiously to annular plaques with uplifted edges and atrophic central skin. [5] Actinic granulomais has been reported to have a slow but self-limited course that can last up to ten years. [3]
Solar-damaged elastic fibers are thought to be the initial cause of this disease, acting as an antigenic trigger for a CD4+ T-helper cell-mediated granulomatous immune response. [5] It has also been linked to long-term doxycycline use. [6]
Actinic granuloma is distinguished histopathologically by multinucleated foreign body giant cells that phagocytize the degenerated elastic fibers, a process known as elastophagocytosis. At the solar elastosis level, there is no necrobiosis, such as facial necrobiosis lipoidica, or mucinosis, such as GA or sarcoid-like granuloma in the dermis. [7]
Because of the similarities in clinical manifestations, Actinic granuloma is easily confused with annular granuloma and sarcoidosis. In such cases, a histopathological examination is required. Annular granuloma is characterized by papules that coalesce into annular plaques and preferentially affect the extensor aspects of the extremities. Sarcoidosis lesions, on the other hand, are typically symmetrically distributed on the face, neck, upper trunk, and extremities, particularly within preexisting scars or near sites of prior trauma. Clinically, it appears as red to red-brown papules and plaques that are sometimes violaceous or annular. Sarcoidosis is distinguished histologically by the appearance of superficial and deep dermal epithelioid cell granulomas without prominent lymphocyte or plasma cell infiltrates. [5]
Actinic granuloma does not have a specific treatment. Some patients experience spontaneous remission of skin lesions. For widespread AG, systemic glucocorticoids, hydroxychloroquine, and niacinamide are effective, and topical glucocorticoids or retinoids can be used. [5] Actinic granuloma has also been successfully treated with pulsed-dye laser therapy and fractionated carbon dioxide laser therapy. [8]
A granuloma is an aggregation of macrophages that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such substances include infectious organisms including bacteria and fungi, as well as other materials such as foreign objects, keratin, and suture fragments.
A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this system is as a barrier against the external environment.
Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a pre-cancerous area of thick, scaly, or crusty skin. Actinic keratosis is a disorder of epidermal keratinocytes that is induced by ultraviolet (UV) light exposure. These growths are more common in fair-skinned people and those who are frequently in the sun. They are believed to form when skin gets damaged by UV radiation from the sun or indoor tanning beds, usually over the course of decades. Given their pre-cancerous nature, if left untreated, they may turn into a type of skin cancer called squamous cell carcinoma. Untreated lesions have up to a 20% risk of progression to squamous cell carcinoma, so treatment by a dermatologist is recommended.
A pyogenic granuloma or lobular capillary hemangioma is a vascular tumor that occurs on both mucosa and skin, and appears as an overgrowth of tissue due to irritation, physical trauma, or hormonal factors. It is often found to involve the gums, skin, or nasal septum, and has also been found far from the head, such as in the thigh.
Granuloma annulare (GA) is a common, sometimes chronic skin condition which presents as reddish bumps on the skin arranged in a circle or ring. It can initially occur at any age, though two-thirds of patients are under 30 years old, and it is seen most often in children and young adults. Females are two times as likely to have it as males.
Lichen nitidus is a chronic inflammatory disease of unknown cause characterized by 1–2 mm, discrete and uniform, shiny, flat-topped, pale flesh-colored or reddish-brown papules that may appear as hypopigmented against dark skin. Occasionally, minimal scaling is present or can be induced by rubbing the surface of the papules. The disease usually affects children and young adults and is painless and usually nonpruritic, although protracted itching may occur in some cases. It is sometimes referred to by dermatologists as "mini lichen planus".
Anetoderma is a benign but uncommon disorder that causes localized areas of flaccid or herniated sac-like skin due to a focal reduction of dermal elastic tissue. Anetoderma is subclassified as primary anetoderma, secondary anetoderma, iatrogenic anetoderma of prematurity, congenital anetoderma, familial anetoderma, and drug-induced anetoderma.
Kyrle disease is identified as a form of an acquired perforating disease. Other major perforating diseases are elastosis perforans serpiginosa and reactive perforating collagenosis. Recently, however, there is a controversy on categorizing Kyrle disease with perforating dermatosis or a subtype of acquired perforating collagenosis.
Eccrine angiomatous hamartoma (EAH), first described by Lotzbeck in 1859, is a rare benign vascular hamartoma characterized histologically by a proliferation of eccrine and vascular components. EAH exists on a spectrum of cutaneous tumors that include eccrine nevus, mucinous eccrine nevus and EAH. Each diagnostic subtype is characterized by an increase in the number as well as size of mature eccrine glands or ducts, with EAH being distinguished by the added vascular component.
Acrokeratoelastoidosis of Costa or Acrokeratoelastoidosis is a hereditary form of marginal keratoderma, and can be defined as a palmoplantar keratoderma. It is distinguished by tiny, firm pearly or warty papules on the sides of the hands and, occasionally, the feet. It is less common than the hereditary type of marginal keratoderma, keratoelastoidosis marginalis.
Porokeratosis is a specific disorder of keratinization that is characterized histologically by the presence of a cornoid lamella, a thin column of closely stacked, parakeratotic cells extending through the stratum corneum with a thin or absent granular layer.
Annular erythema of infancy(AEI) consists of self-limited eruptions of erythematous, annular to polycyclic patches and plaques. It is an idiopathic figurate erythema. Over several days, a single lesion disappears without leaving behind any scale or hyperpigmentation. Mostly affecting the trunk, face, and extremities, this rash has no symptoms. The diagnosis of AEI is made through a combination of histopathologic and clinical examinations. The disease first manifests in infancy, and if treatment is not received, the periodic eruptions usually stop after the first year of life.
Acral persistent papular mucinosis (APPM) is a rare form of lichen myxedematosus. It is characterized by small papules on the backs of the hands, wrists, and extensor aspects of the distal forearms, with no further clinical or laboratory indications. Lesions tend to persist and may grow in number gradually. Because there are no symptoms, treatment is rarely required.
Majocchi's granuloma is a skin condition characterized by deep, pustular plaques, and is a form of tinea corporis. It is a localized form of fungal folliculitis. Lesions often have a pink and scaly central component with pustules or folliculocentric papules at the periphery. The name comes from Domenico Majocchi, who discovered the disorder in 1883. Majocchi was a professor of dermatology at the University of Parma and later the University of Bologna. The most common dermatophyte is called Trichophyton rubrum.
Annular elastolytic giant-cell granuloma is a cutaneous condition characterized histologically by a dermal infiltrate of macrophages.
Granuloma multiforme is a cutaneous condition most commonly seen in central Africa, and rarely elsewhere, characterized by skin lesions that are on the upper trunk and arms in sun-exposed areas. It may be confused with tuberculoid leprosy, with which it has clinical similarities. The condition was first noted by Gosset in the 1940s, but it was not until 1964 that Leiker coined the term to describe "a disease resembling leprosy" in his study in Nigeria.
Sarcoidosis, an inflammatory disease, involves the skin in about 25% of patients. The most common lesions are erythema nodosum, plaques, maculopapular eruptions, subcutaneous nodules, and lupus pernio. Treatment is not required, since the lesions usually resolve spontaneously in two to four weeks. Although it may be disfiguring, cutaneous sarcoidosis rarely causes major problems.
Childhood granulomatous periorificial dermatitis (CGPD), is a rare benign granulomatous skin disease of unknown cause. The disorder was first described in 1970 by Gianotti in a case series of five children. CGPD is more common in boys than girls.
Crohn's disease (CD) of the vulva is a rare extra intestinal condition, with granulomatous cutaneous lesions affecting the female genitalia. Lesions connected to the affected gut via a healthy tissue are referred to as metastatic lesions.