Actinic granuloma

Actinic granuloma is a rare, idiopathic disorder of middleaged adults that always appears in sun-exposed skin [1,2]. It is a form of granulomatous dermatosis characterized by annular plaques with central atrophy and raised erythematous margins that are similar to those observed in granuloma annulare (GA) [3]. A 42-year-old man presented with a three-month history of an asymptomatic erythematous annular and serpiginous lesion on his forehead. There was no history of preceding trauma to the area. He was not on any medications. Examination revealed an erythematous to brown annular to serpiginous plaque with central atrophy (Figure 1). Systemic examination revealed no abnormalities. Results of full blood count and multiple biochemical analyses were unremarkable. Skin biopsy showed normal epidermis with significant solar elastosis and granulomatous reaction in dermis, composed of numerous multinucleated giant cells. There was no area of necrobiosis. Verhoeff von Gieson stained sections revealed loss of elastic fiber in the center but the presence of fragments of elastin within the giant cells (Figure 2). Alcian blue staining was negative of mucin (Figure 3). O’Brien’s actinic granuloma is a chronic disease that affects middle-aged individuals of either sex who have a history of intense sun exposure [3]. It begins as small skinActinic granuloma