Piqué-Duran Enric, Azcue-Mayorga Mikel, Roque-Quintana Belinda, García-Vázquez Odalys, Ruedas-Martínez Antonio
Dermatology Department, Dr José Molina Orosa Hospital, 35500 Arrecife, Spain.
Pathology Department, Dr José Molina Orosa Hospital, 35500 Arrecife, Spain.
Dermatopathology (Basel). 2025 May 29;12(2):16. doi: 10.3390/dermatopathology12020016.
A 71-year-old Caucasian woman presented with lesions on both elbows. A physical examination revealed arcuate plaques with raised erythematous edges and central clearing. Comedones and cysts were evident on the border of the lesions. The dermatoscopic view showed the presence of pores, in addition to granuloma annulare changes. The biopsies showed changes according to granuloma annulare, but the granulomas were closely related to comedones and cysts. Furthermore, the presence of elastophagocytosis via multinucleated Langhans-type giant cells was evident. Verhoeff-van Gieson staining highlighted the transepithelial elimination of elastic fibers in the bottom of some cysts. The presence of comedones or cysts is exceptional in granuloma annulare. Only four similar cases have been reported. Although all previous cases showed lesions in sun-exposed areas over photodamaged skin, only our case showed transepithelial elimination of elastic fibers. Diabetes mellitus (DM) could play a role in the pathogenesis of this variant of actinic granuloma annulare, because most cases are associated with uncontrolled DM and the lesions improve after DM is controlled.
一名71岁的白种女性双肘出现皮损。体格检查发现为弓形斑块，边缘红斑隆起，中央有消退。皮损边界可见粉刺和囊肿。皮肤镜检查除环状肉芽肿改变外，还可见毛孔。活检显示符合环状肉芽肿的改变，但肉芽肿与粉刺和囊肿密切相关。此外，可见多核朗汉斯型巨细胞进行弹性组织吞噬。Verhoeff-van Gieson染色突出显示一些囊肿底部弹性纤维的经上皮清除。粉刺或囊肿在环状肉芽肿中较为罕见。仅报道过4例类似病例。尽管之前所有病例的皮损均位于光损伤皮肤的暴露部位，但只有我们的病例显示有弹性纤维的经上皮清除。糖尿病可能在这种光化性环状肉芽肿变体的发病机制中起作用，因为大多数病例与糖尿病控制不佳有关，且糖尿病得到控制后皮损会改善。
