Granuloma Annulare with Transfollicular Perforation

Abstract

In recent years the phenomenon of transepithelial elimination has been found to be the underlying mechanism in a variety of skin disorders. "Perforating dermatoses" may show transepidermal or transfollicular elimination or a combination of the two. A case of papular granuloma annulare is reported, where in one lesion the pilary apparatus actively participated in the elimination of necrobiotic collagen from the dermis. To our knowledge, perforating granuloma annulare with a transfollicular pathway has not previously been described. Also, a classification of perforating dermatoses is presented.

Granuloma annulare with Follicular Perforation

“…Therefore, it is by no means surprising that the hair follicle should engage in the toilet of the surrounding dermis. It must be emphasized, however, that in the present case, in contrast to the previous observation [3], inflammatory focal destruction of the follicular wall was not accompanied by a hyper plastic epithelial response. The vis a tergo from the lesions in the dermis was most likely responsible for the propulsion of the necrobiotic material through the ruptured epithelium.…”

“…For instance, both transepidermal and transfollicular elimination occur in the elastosis perforans serpiginosa group of disorders. The present case as well as a previous observation [3] indicate that the transfollicular route of elimination is also taken in granuloma annulare.…”

“…If dili gently searched for, it may not be as rare as the few reports in the literature suggest [1,2, 8-11, 13, 14, 16, 17,22,26,27], It has been shown previously that the hair follicle may be actively and exclusively involved in the perforation process [3]. This has been also demonstrated in another necrobiotic dermal disorder: necrobiosis lipoi dica [23].…”

Reactive Perforating Collagenosis and Phototraumatism

“…In addition, the primary perforating disorders, elastosis perforans, serpiginous perforating folliculitis, Kyrle's disease, per forating elastoma [4], and adult acquired reactive perforating collagenosis with either diabetes or chronic renal failure [5] may be ruled out by the different course of the dis ease. Cutaneous diseases which have perfo ration as a secondary characteristic arc gran uloma annulare, pseudoxanthoma elasticum, and chondrodermatitis nodularis chronica helieis, and should be diagnosed clinically by the primary disease present.…”

Collagenolytic (necrobiotic) granulomas: part 1 – the ‘blue’ granulomas

“…The protruding necrobiotic collagen is eliminated either directly through the epidermis or through a follicle to the surface. 42,48 Generalized GA lesions have palisading granulomas with masses of intercellular fibrin material not seen in other clinical forms of GA. Thick and multilayered basal lamina around lesional capillaries is more common in this form, suggesting that a more pronounced immune reaction is responsible for generalized GA. 49 Although the generalized forms of GA can have an interstitial pattern, just as the localized variant can, it is less likely to be present within the perforating or subcutaneous forms of GA.…”