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Dermoscopy of annular elastolytic giant cell granuloma in fitzpatrick skin V skin


1 Department of Dermatology, Venerology and Leprology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
2 Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India

Date of Web Publication20-Jun-2021

Correspondence Address:
Payal Chauhan,
Department of Dermatology, Venereology and Leprology, Himalayan Institue of Medical Sciences, Dehradun, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_849_20



How to cite this URL:
Chauhan P, Jindal R, Shirazi N. Dermoscopy of annular elastolytic giant cell granuloma in fitzpatrick skin V skin. Indian Dermatol Online J [Epub ahead of print] [cited 2021 Sep 28]. Available from: https://www.idoj.in/preprintarticle.asp?id=318494



A 47-year-old female of Fitzpatrick skin type V presented to the dermatology outpatient department with complaints of sudden onset raised lesions chest for 1 month. There were no systemic complaints or history of using topical or oral medications. On examination, multiple, skin-colored, infiltrated papules clustered in an arciform arrangement were seen [Figure 1]. Dermoscopic examination using DermLite DL4 (3Gen, San Juan Capistrano, California, USA) was done which showed structureless yellow-brown structureless areas, white areas with multiple well-focused linear irregular and reticular vessels over a pale pink background [Figure 2]. Skin biopsy done with a differential diagnosis of papular granuloma annulare, papular sarcoidosis, actinic granuloma, and pseudoxanthoma elasticum-like papillary dermal elastolysis, revealed thinned out and atrophic epidermis, upper and mid-dermis showed granuloma composed of histiocytes, lymphocytes, foreign body and Langhan's type giant cell with partly degenerated elastic fibers and prominent elastopagocytosis [Figure 3]. There was no mucin deposition or collagen disruption. Von Gieson stain showed loss of elastic fibers in the granulomatous infiltrate. A final diagnosis of annular elastolytic giant cell granuloma was established after clinicopathological correlation. The patient was started on pimecrolimus 1% cream twice daily and is under follow-up.
Figure 1: Multiple, skin coloured, infiltrated papules arranged in an arciform configuration (black arrow) over photo-exposed part of upper chest

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Figure 2: Yellowish-orange structureless areas (blue star), white areas (black arrow), and well-focused linear irregular and reticular vessels (blue arrow) over pale pink background. Pigmentation structures (blue circle) were also seen. (DermLite DL4, 10×, polarized mode, 3Gen, San Juan Capistrano, California, USA)

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Figure 3: (a) Histopathological examination shows thinned out atrophic epidermis with poorly circumscribed granuloma in upper and mid-dermis (H and E, 4×); (b) Granuloma composed of lymphocytes, histiocytes, foreign body, and Langhan's giant cells with degenerated elastic fibers in center of the granuloma (H and E, 10×); (c) elastic fiber engulfed by macrophages denoting elastophagocytosis (black arrow) (H and E, 40×)

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Annular elastolytic giant cell granuloma (AEGCG) is a granulomatous disorder that presents as annular plaques having subtle raised edges peripherally with hypopigmentation and/or atrophy in the center. The plaques are seen to involve sun-exposed areas more frequently than sun-protected sites. The disease is thought to start as papules in the initial stage which extend centrifugally to form a serpiginous annular pattern.[1],[2] The reported case represents papular variant of AEGCG. On a detailed literature search, we came across only one previous report describing dermoscopy of AEGCG, and none describing the findings in the skin of color. Errichetti et al., noted yellowish-orangish structureless areas, whitish-gray scaling at the periphery, and well-focused reticular vessels over a pale pinkish background in the center.[3] In the present case, we found white areas that correspond to the loss of elastic fibers in the dermis, well-focused vessels which become prominent secondary to epidermal atrophy, and yellowish-brown structureless areas that denote underlying dermal granulomas. Yellowish-brown areas are seen commonly in patients of darker skin type with granulomatous disorders. The differentiation between the peripheral and central zone was not prominent in the present case which could be attributed to the early papular stage of the disease. Presence of well-focussed vessels visualized in dermoscopy of AEGCG help differentiate it from granuloma annulare where blurry or unfocused vessels are found.[4] Although, yellowish-orange structureless areas and well-focussed vessels are found in dermoscopy of both sarcoidosis and AEGCG, concurrent presence of white areas point toward the latter.[5] Dermoscopy of differentials of the present case is summarized in [Table 1]. Dermoscopy can be a useful tool aiding in the diagnosis of AEGCG and more studies are needed in this field.
Table 1: Dermoscopic findings of annular elastolytic giant cell granuloma and its differentials

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.[6]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kato H, Kitajima Y, Yaoita, H. Annular elastolytic giant cell granuloma: An unusual case with papular lesions. J Dermatol 1991;18:667-70.  Back to cited text no. 1
    
2.
Marmon S, O'Reilly KE, Fischer M, Meehan S, Machler B. Papular variant of annular elastolytic giant-cell granuloma. Dermatol Online J 2012;18:23.  Back to cited text no. 2
    
3.
Errichetti E, Cataldi P, Stinco G. Dermoscopy in annular elastolytic giant cell granuloma. J Dermatol 2019;46:e66-7.  Back to cited text no. 3
    
4.
Errichetti E, Lallas A, Apalla Z, Di Stefani A, Stinco G. Dermoscopy of granuloma annulare: A clinical and histological correlation study. Dermatology 2017;233:74-9.  Back to cited text no. 4
    
5.
Chauhan P, Meena D, Hazarika N. Dermoscopy of sarcoidosis: A useful clue to diagnosis. Indian Dermatol Online J 2018;9:80-1.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Kawashima S, Togawa Y, Miyachi H, Matsue H. Dermoscopic features of pseudoxanthoma elasticum. Clin Exp Dermatol 2018;43:175-9.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

 
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