Granuloma actinic L92.2

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 08.10.2021

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actinic granuloma; Actinic granuloma; AEGCP; annular elastolytic giant cell granuloma; atypical necrobiosis lipoidica fo the face and scalp; giant cell elastophagocytosis; Miescher`s granuloma of the face

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O'Brian, 1975

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First described by O'Brian as a giant cell containing granuloma at the bottom of an actinic damage. Later investigations cast doubt on the validity of chronic UV damage as a triggering agent. Furthermore, it was shown that this disease had already been described under other names before O'Brian (see above). As variants (or also synonymously) the granuloma multiforme and the granuloma anulare are regarded. The anular elastolytic giant cell granuloma may also be regarded as synonymous with actinic granuloma.

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From the age of 40. Preferentially affects women. All ethnic groups are affected.

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Light, infrared or heat damaged skin areas, especially the face.

Clinical features
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Slightly pruritic, but also completely asymptomatic, skin-coloured to red or red-brown, non-scaling, firm papules and plaques, which slowly expand centrifugally, heal centrally and thus form anular structures . Circular formations are also possible due to confluence of multiple foci.

The center of the plaques is usually atrophically sunken, the margins prominently palpable.

The changes may also occur in the area of the conjunctiva. In a larger collective, diabetes mellitus was detected in 40% of patients (Gutiérrez-González E et al. 2015).

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Sarcoid granulomas with giant cells and amorphously deposited elastotic material in the upper dermis.

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Light protection, reduction of sun exposure.

Good response to intralesional glucocorticoid injections with e.g. triamcinolone acetonide solution(e.g. Volon A 10 mg, diluted 1:3-1:5 with the local anaesthetic scandicaine).

According to individual case reports, systemic application of isotretinoin (e.g., Isotretinoin-ratiopharm; Isoderm) 0.5 mg/kg bw is effective. Recently, TNF-alpha blockers have also been used (Chen A et al. 2019).

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Healing mostly after several years.

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  1. Al-Hoqail IA et al (2002) Actinic granuloma is a unique and distinct entity: a comparative study with granuloma annulare. Am J Dermatopathol 24: 209-212
  2. Chen A et al (2019) The role of biologics in the treatment of chronic granuloma annulare. Int J Dermatol 58: 622-626.
  3. Gutierrez-Gonzalez E et al (2013) Elastolytic giant cell granuloma: clinic-pathologic review of twenty cases. Dermatol Online J 19:20019
  4. Gutiérrez-González E et al (2015) Elastolytic actinic giant cell granuloma. Dermatol Clin 33:331-341.
  5. Konar K et al (2014) Annular elastolytic giant cell granuloma of conjunctiva: a case report. Indian J Ophthalmol 62:361-363
  6. Lim DS, Triscott J (2003) O'Brien's actinic granuloma in association with prolonged doxycycline phototoxicity. Australas J Dermatol 44: 67-70
  7. Limas C et al (2004) The spectrum of primary cutaneous elastolytic granulomas and their distinction from granuloma annulare: a clinicopathological analysis. Histopathology 44: 277-282
  8. McGrae JD (1986) Actinic granuloma. Arch Dermatol 122: 43-47
  9. O'Brian JP (1975) Actinic granuloma. An annular connective tissue disorder affecting sun- and heat-damaged (elastotic) skin. Arch Dermatol 111: 460-466
  10. Ragaz A et al (1979) Is actinic granuloma a specific condition? Am J Dermatopathol 1: 43-50
  11. Steinhoff M et al (2001) Figurated plaque on actinically damaged skin. Actinic O'Brien granuloma. Dermatologist 52: 551-553


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Last updated on: 08.10.2021