Actinic Granuloma

A 50-year-old woman presented with an 18-month history of asymptomatic skin lesions on her forehead (Panel A) and the dorsum of her hands (Panels B and C). The lesions were well demarcated, erythematous, coalescing annular plaques with raised borders and slightly atrophic centers. Over time, the lesions gradually increased in number and slowly extended centrifugally. A skin biopsy showed a lymphohistiocytic infiltrate with multinucleated giant cells and surrounding solar elastosis, without apparent palisading, necrobiosis, or mucin deposition. Fragmentation of the elastic fibers and occasional elastophagocytosis by giant cells in the granulomatous area were noted — findings that supported a diagnosis of actinic granuloma. Actinic granuloma is an asymptomatic granulomatous reaction that affects sun-exposed skin, most commonly on the face, neck, and scalp. It is characterized by annular or polycyclic lesions that slowly expand centrifugally and have an erythematous elevated edge and a hypopigmented, atrophic center. The patient was advised to reduce her exposure to the sun and to use sunscreen. Treatment with topical halometasone cream on the dorsum of her hands and with pimecrolimus cream on her forehead was started; at 2 months, there was a partial response.Dong-Lai Ma, M.D., Ph.D., and Sergio Vano-Galvan, M.D., Ph.D. N Engl J Med 2017; 376:475