Granuloma actínico de O'Brien: apresentação clínica exuberante

Abstract

O'Brien's actinic granuloma is a rare skin disease. Controversy continues over whether it should be considered a specific condition or a form of granuloma annulare located in sun-exposed areas. Its pathogenesis is unknown; however, the most widely accepted hypothesis suggests that solar radiation is the triggering factor. This paper describes the case of a 78-year old, fair-skinned male, who presented with a 10-year history of an infiltrate of annular erythematous papules on his forehead and left malar region. The diagnosis of O'Brien actinic granuloma was established from histopathology, since the clinical condition of the patient was extensive, unlike cases reported in the literature. Keywords: Giant cells; Granuloma; Granuloma, giant cell Resumo: O granuloma actínico de O'Brien é uma doença cutânea rara. Há muitas controvérsias na sua caracterização, podendo representar uma entidade nosológica distinta ou uma forma de granuloma anular em áreas expostas. A patogênese é desconhecida; no entanto, acredita-se que a radiação solar seja um fator desencadeante. Os autores relatam o caso de um paciente de 78 anos, branco, que apresentava há 10 anos pápulas eritematosas e infiltradas na fronte e hemiface à esquerda. O diagnóstico de granuloma actínico de O'Brien foi estabelecido a partir do exame histopatológico, uma vez que o quadro clínico exuberante apresentado pelo paciente diferia do de casos anteriormente observados.

Actinic granuloma

“…It is a form of granulomatous dermatosis characterized by annular plaques with central atrophy and raised erythematous margins that are similar to those observed in granuloma annulare (GA) [3]. …”

“…O’Brien’s actinic granuloma is a chronic disease that affects middle-aged individuals of either sex who have a history of intense sun exposure [3]. It begins as small skin-colored or pink papules that quickly evolve into annular plaques.…”

“…The border of the lesion extends slowly at the periphery while the center returns to a slightly atrophic appearance [1]. The pathogenesis of the condition is unknown; however, solar elastosis of sun damage is believed to be a triggering factor [1,3]. It is also reported in association with prolonged doxycycline [4].…”

“…There is an absence of necrobiosis, such as facial necrobiosis lipoidica, or mucinosis, such as GA or sarcoid-like granuloma in the dermis at the solar elastosis level [1,3]. …”

“…Several forms of treatment with varying results have been reported, such as with chloroquine, cyclosporine, intralesional steroids, cryotherapy, methotrexate, isotretinoin, acitretin, pentoxiphylline, and retinoid psoralen + UVA (RePUVA) [3,10]. Spontaneous remission has been reported in some cases [3].…”