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Visual Treats in Dermatology
2022
:2;
87
doi:
10.25259/CSDM_70_2022

Comedonal granuloma annulare

Department of Dermatology, All India Institute of Medical Sciences, Bathinda, Punjab, India
Corresponding author: Priya Kapoor, Department of Dermatology, All India Institute of Medical Sciences, Bathinda, Punjab, India. kapoorpriya2492@gmail.com
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Kapoor P, Kumar S. Comedonal granuloma annulare. CosmoDerma 2022;2:87.

A 56-year aged female presented to us with erythematous lesions on forearms for 3 years. Physical examination showed erythematous papules and plaques on extensor surface of forearms. The largest plaque had raised borders studded with open comedones [Figure 1]. All routine investigations were normal. Dermoscopy showed blurry vessels over a pinkish-red background, yellowish-orange structureless areas, and open comedones filled with keratotic plugs [Figure 2].

Figure 1:: Erythematous papules and annular plaques with open comedones overlying the largest plaque.
Figure 2:: Dermoscopy showing blurry vessels over a pinkish-red background, yellowish-orange structureless areas, and open comedones filled with keratotic plugs (Dermlite DL4, ×10).

Skin biopsy showed a palisading granuloma in reticular dermis around focus of fibrin and mucin deposition and incomplete collagen degeneration. Dilated follicular infundibulum filled with keratinous material corresponding to a comedo was seen [Figure 3].

Figure 3:: Palisading granuloma around focus of fibrin and mucin deposition and incomplete collagen degeneration. Dilated follicular infundibulum filled with keratinous material is seen adjacent to the granuloma (H&E, 200×).

Degeneration of collagen and elastin is a hallmark histological feature of granuloma annulare. Loss of dermal support induces distension of infundibular canal of sebaceous follicle resulting in open comedones overlying lesions of granuloma annulare.[1] Comedonal granuloma annulare should be differentiated from perforating granuloma annulare, actinic comedonal plaque, granuloma multiforme, and annular elastolytic giant cell granuloma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , . Open comedones overlying granuloma annulare in a photoexposed area. Photodermatol Photoimmunol Photomed. 2006;22:273-4.
    [CrossRef] [PubMed] [Google Scholar]

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