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Actinic Granuloma - Submitted on: Tuesday April, 02, 2002
Contributed by:Arash Radfar, MD PhD, Arash Radfar, MD PhD
Actinic Granuloma was recognized as a separate clinico-pathological entity by O'Brien in 1975 (ref.1), who described several ring shaped inflammatory plaque-like lesions occurring on the sun exposed skin, associated with characteristic histopathological picture. Some authors consider actinic granuloma as a variant of granuloma annulare of sun damaged skin. We believe that the clinical and pathological characteristics of actinic granuloma warrant its recognition as a separate entity.


Definition:
Actinic granuloma is a chronic plaque-like and often annular cutaneous photoeruption with mixed inflammatory dermal infiltrate numerous multinucleated giant cells and prominent elastolysis

Clinical Features:
The lesion occur on the sun exposed areas including neck, face, chest and arms. The patients are usually more then 30 years of age. The lesion occurs in both sexes.
Actinic granulomas present as variable-sized plaques with slightly raised annular border. The center of the lesion can be depressed They may be solitary or grouped. There is usually a history of slow growth with steady progression. Clinical differential diagnoses include basal cell carcinoma, and annular dermatoses such as granuloma annulare, erythema annulare centrifugum and Majocchi’s purpuric dermatitis.

Histology:
Figures
(Click on an image for a larger view)
Figure 1
Figure 2
Figure 3
Actinic granuloma is morphologically characterized by a localized chronic inflammatory reaction accompanied by elastolysis (ref.2). It arises on sun-damaged skin typically with prominent solar elastosis. The center of the lesion is typically atrophic and shows loss of elastic fibers. The peripheral zone shows the most characteristic features. There is dermal histiocyte-rich infiltrate with numerous giant cells accompanied by variable amount of lymphocytes (T-helper), eosinophils, neutrophils and plasma cells (Figures 1-3). Histiocytes and giant cells often cluster around altered sun-damaged elastic fibers. Elastophagocytosis is present. Three main variants, giant cell, necrobiotic (vascular) and histiocytic have been described. These variants have descriptive value and have overlapping clinical and histological features.
        Immunohistochemistry studies showed the presence of T-hepler lymphocytes in the lesion (ref.4) and the presence of of lysozyme in the giant cells is shown by immunoperoxidase technique.


Treatment:
Actinic granuloma is a chronic disease refractory to treatment. After a period of slow progression over months or years, the inflammatory process slows down and the lesions regress often with residual dermal atrophy. Intralesional steroids may be used in active disease.

There is a report of partial response to the treatment of actinic granuloma with pentoxifylline (ref.3).


Bibliography:
  • O'Brien JP. Actinic granuloma. Arch Dermatol 1975; 111: 460-466.
  • O'Brien JP. Actinic granuloma : The expanding significance. International Journal of Dermatology 1985; 24: 473-490
  • Rubio, Francisco A., Robayna, Goretti, Pizarro, Angel, de Lucas, Raul, Herranz, Pedro, Casado, Mariano. Section Editor(s): Actinic granuloma and vitiligo treated with pentoxifylline. 1998; 37: 958-960.
  • McGrae, JD. Actinic granuloma. A clinical, histopathologic, and imunocytochemical study. Archives of Dermatology. 1986, 122: 43-7.
     

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