Letter - Clinical
Annular elastolytic giant cell granuloma: an unusual presentation in non-sun-exposed areas
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Dermoscopy (magnification 20×) showing unstructured orange zones on an erythematous background (C)</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 76-year-old man with a prior diagnosis of type 2 diabetes mellitus and hypertension consulted our Dermatology practice with a 20-year history of progressive pruritic lesions. He had been previously treated with topical antifungals and corticosteroids without response.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed multiple, large, well-circumscribed annular plaques on the trunk, back and arms. Lesions showed central healing surrounded by a red inflammatory zone and a palpable erythematous border on the extreme periphery of the plaques. Post-inflammatory hyperpigmentation was also noted (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and <a class="elsevierStyleCrossRef" href="#fig0005">1</a> B). Dermoscopy on the periphery of the lesions showed unstructured orange zones on an erythematous background, with some whitish areas and fine vessels on the surface (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A cutaneous biopsy of the lesion border was performed; histopathological analysis on the H-E stain showed multiple foci of histiocytic and multinucleated giant cells and areas of collagen degeneration on the dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and <a class="elsevierStyleCrossRef" href="#fig0010">2</a> B). No increase in interstitial mucin was observed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). Verhoeff's Van Gieson stain showed elastoclasia and loss of elastic fibers in the foci of histiocytic infiltrate (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B and <a class="elsevierStyleCrossRef" href="#fig0015">3</a> C). Given the clinical presentation and histopathological analysis, Annular Elastolytic Giant Cell Granuloma (AEGCG) was diagnosed.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">AEGCG is a rare cutaneous granulomatous disease of unknown etiology. It was first described by O'Brien in 1975 as a variant of granuloma annulare located in photo-exposed areas.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, it is now considered a distinct entity given its characteristic histopathological findings: non-palisading granulomas in the superficial dermis, abundant multinucleated giant cells, marked elastophagocytosis, and absence of mucin and necrobiosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">It has been proposed that factors such as ultraviolet radiation, heat, and vascular damage could generate elastolysis and an antigenic change of the elastic fibers, triggering a cellular immune response and a consequent granulomatous reaction.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> AEGCG has been associated with diabetes mellitus, hyperlipidemia, hypertension, vascular occlusion, arthritis and hematological and solid organ malignancies.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Clinically, it is characterized by photo-distributed, slow-growing annular papules or plaques with erythematous borders and a slightly hypopigmented or atrophic center.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Papular, reticular forms, and variants that involve non-exposed areas -as in our case- have been described.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Dermoscopically, unstructured yellow-orange areas and desquamation in the periphery have been reported, with homogeneous reticular vessels in the center of the lesion.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">We examined our patient and comorbidities were not found, age-appropriate cancer screening was negative. Because our patient was an underground mining worker for over 30 years, we hypothesize that the unusual distribution of his lesions may be explained by heat rather than sunlight exposure.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The differential diagnosis includes other granulomatous and annular diseases such as tinea corporis, leprosy, tuberculosis, sarcoidosis, granuloma annulare and necrobiosis lipoidica.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The histopathological analysis is crucial for a correct diagnosis. Mycotic and mycobacterial cultures may also be necessary to exclude infectious diseases.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We present a case of AEGCG in non-sun-exposed areas, which had been misdiagnosed and mistreated for decades. AEGCG is a rare disease that must be included in the differential diagnosis of annular plaques, in which a biopsy is critical to exclude other autoimmune and infectious diseases.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Authors' contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Claudia Suárez: Approval of the final version of the manuscript; intellectual participation in propaedeutic and/or therapeutic management of studied cases; manuscript critical review; preparation and writing of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Gonzalo Hevia: Approval of the final version of the manuscript; critical literature review; manuscript critical review; preparation and writing of the manuscript.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Catalina Silva-Hirschberg: Approval of the final version of the manuscript; critical literature review; manuscript critical review; preparation and writing of the manuscript.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Alex Castro: Approval of the final version of the manuscript; manuscript critical review; preparation and writing of the manuscript.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-01-19" "fechaAceptado" => "2022-02-24" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital Padre Hurtado, Santiago, Chile.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 864 "Ancho" => 1555 "Tamanyo" => 210901 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Annular plaques on the trunk and arms; anterior (A) and posterior view (B). Dermoscopy (magnification 20×) showing unstructured orange zones on an erythematous background (C)</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 550 "Ancho" => 1505 "Tamanyo" => 395043 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Hematoxylin & eosin, 100×; perivascular and interstitial infiltrate with lymphocytes and numerous histiocytes. Collagen degeneration areas surrounded by multiple histiocytes and multinucleated giant cells. (B) Hematoxylin & eosin, 200×; collagen degeneration on the dermis</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 719 "Ancho" => 1955 "Tamanyo" => 521819 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Alcian blue, 100×; absence of mucin. (B) Verhoeff-Van Gieson elastic, 200×; elastophagocytosis and elastoclasia in the active border of a plaque. (C) Verhoeff-Van Gieson elastic, 200×; absence of elastic fibers in the central area of the same plaque</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can methotrexate be a successful treatment for unresponsive generalized annular elastolytic giant cell granuloma? Case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Burlando" 1 => "A. Herzum" 2 => "E. Cozzani" 3 => "M. Paudice" 4 => "A. Parodi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/dth.14705" "Revista" => array:5 [ "tituloSerie" => "Dermatol Ther." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 25 | 9 | 34 |
| 2024 October | 166 | 59 | 225 |
| 2024 September | 223 | 74 | 297 |
| 2024 August | 216 | 114 | 330 |
| 2024 July | 213 | 104 | 317 |
| 2024 June | 151 | 69 | 220 |
| 2024 May | 169 | 60 | 229 |
| 2024 April | 181 | 85 | 266 |
| 2024 March | 98 | 73 | 171 |
| 2024 February | 106 | 92 | 198 |
| 2024 January | 118 | 67 | 185 |
| 2023 December | 675 | 95 | 770 |
| 2023 November | 298 | 135 | 433 |
| 2023 October | 322 | 102 | 424 |
| 2023 September | 67 | 77 | 144 |
| 2023 August | 74 | 34 | 108 |
| 2023 July | 46 | 56 | 102 |
| 2023 June | 4 | 6 | 10 |
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