Granuloma Annulare – Actinic Granuloma
Actinic Granuloma, also called Granuloma of Obrien, is a type of Granuloma Annulare induced by sun exposure which I encounter frequently in both my The Woodlands Dermatology and Conroe Dermatology offices. Actinic Granuloma is found on sun exposed skin with the posterior neck and arms being very commonly affected areas. Clinically, the lesions in Actinic Granuloma resemble typical Granuloma Annulare plaques. The inflammatory process in Actinic Granuloma can extend to non sun exposed areas. Unlike classic Granuloma Annulare which is usually asymptomatic, patients with Actinic Granuloma typically experience intense pruritus. Most patients with Actinic Granuloma are over age 50. Treatment involves strict sun protection as well as intralesional kenalog injections. Actinic Granuloma is not associated with diabetes but there is an association with temporal arteritis, which may also be induced by sun damage around the temporal artery. Annulare Elastolytic Giant Cell Granuloma (AEGCG) is a condition that is sun induced and is histologically very similar to Actinic Granuloma so it is in the differential diagnosis. AEGCG appears like Necrobiosis Lipoidica Diabeticorum except the yellowish plaque is on the forehead and not the anterior lower legs. There is also a variant of AEGCG that occurs as multiple lesions on the chest and back of women.