Annular elastolytic giant cell granuloma: sparing of a burn scar and successful treatment with chloroquine

Abstract

Annular elastolytic giant cell granuloma is a rare granulomatous skin disease characterized by phagocytosis of elastic fibres by multinucleated giant cells. Lesions are either solitary or grouped in a few annular patches with elevated borders and central atrophy. Sun-exposed areas are more commonly involved than covered skin. The pathogenesis of the disease is still controversial. We report a 72-year-old fair-skinned woman with unusual clinical findings. An irregularly shaped erythematous plaque covered the entire face, and hundreds of lichenoid papules were present on both sun-exposed and covered areas which gradually evolved into annular lesions of about 0.5-1 cm in diameter. Sparing of an old burn scar and a nearly complete lack of elastic fibres in the scar site were noted, illustrating the presumed importance of dermal elastic tissue in the pathogenesis. The course of the disease is chronic. Several treatments have been tried, with variable success. In our patient, improvement was achieved with chloroquine over a period of 16 weeks.

Granuloma Anular Elastolítico de Células Gigantes Associado a Policitemia Vera

“…[5][6][7] Esta teoria é suportada pelos achados imuno-histoquímicos que revelam um predomínio de linfócitos CD4 sobre os linfócitos CD8 nas lesões. [6][7][8] No entanto, a doença pode surgir em áreas cobertas [2][3][4][5][6][7][8][9][10][12][13]22 e, num caso foi descrita uma disseminação sistémica (pele, olhos, gânglios linfáticos e aparelho digestivo), 2 o que leva a pensar que podem existir outros fatores para além da radiação ultravioleta que alteram as fibras elásticas e podem desempenhar um papel na patogénese desta doença cutâ-nea. 5 Na maioria dos casos trata-se de uma dermatose 10,22 O nosso caso é, como foi referido, a primeira descrição de associação com a policitemia vera.…”

Regression of Papular Elastolytic Giant Cell Granuloma Using Narrow-Band UVB Irradiation

“…Some unidentified factors, such as ultraviolet radiation, heat or others, might cause the elastic fibers to become antigenic, which could lead to an attack on the altered elastic fibers by infiltrating cells [2], Recently, Fujimoto et al [3] have reported the expression of a 67- kDa elastin receptor in the giant cells of AEGCG, and they suggested that elastic tissues induce factor XIIIa+ cells and CD68+ macrophages to form granuloma or multinucleated giant cells. …”

The Sparing Phenomenon. A case series of the inverse Koebner and related phenomena

“…Psoriasis sparing an area of alopecia areata and previously irradiated site was found in three occasions and non occurrence of drug reaction and CTCL in an area exposed to ultra violet light (swimming suit sparing) were documented in two instances [3][4][5]14,15]. There were two occasions granulomatous skin diseases sparing previous scar tissues [16,17]. There did not seem to be any association between first and second disease, the time gap between two insults were few weeks to 20 years.…”