Abstract
A 44-year-old woman with past medical history presented for evaluation of persistent red-brown macular and reticulated eruption on the neck and bilateral upper arms. Rash is asymptomatic and had been present for five years. The patient was previously treated for presumed tinea versicolor with oral fluconazole, ketoconazole cream and shampoo, and topical triamcinolone without benefit. When she presented to our clinic for evaluation, a biopsy was performed to clarify the diagnosis. Biopsy revealed grey elastic fibers within giant cells. A colloidal iron stain failed to reveal a focal increase in mucin. No evidence of fungal organisms was noted within the keratinizing layer. Diagnosis of macular elastophagocytic granuloma was made.
Actinic granuloma may present in several different ways. Synonyms include annular elastolytic giant cell granuloma of O’Brien, giant cell elastophagocytosis, Miescher’s granuloma of the face, and atypical annular necrobiosis lipoidica of the face and scalp. Lesions are typically annular and occur on sun exposed skin. Macular variants are less common and appear to have less correlation with actinic damage. The etiology is unclear. Biopsy of a mature lesion reveals loss of elastic fibers centrally and elastic fibers within giant cells at the periphery of lesions. Collagen is not altered and there is no focal increase in mucin. Treatment with antimalarial agents such as hydroxychloroquine have been associated with improvement.