O'Brien's actinic granuloma in association with prolonged doxycycline phototoxicity

Abstract

O'Brien's actinic granuloma is clinically characterized by annular papules and plaques on sun-exposed areas of skin. These lesions often occur insidiously on a background of severe solar elastosis; however, an acute variant following sunburn has been reported in the literature. We present two cases of acute actinic granuloma precipitated by episodes of sunburn occurring on a background of prolonged doxycycline phototoxicity. Biopsies from both patients showed a histiocytic infiltrate with multinucleate giant cells engulfing elastotic material, with a reduction of elastin towards the centre of the papule. Marked resolution of the lesions was noted after 8 weeks of treatment with betamethasone dipropionate 0.05% ointment in optimized vehicle together with adequate photoprotection in the form of broad-spectrum sunscreens.

Granuloma actínico de O'Brien: apresentação clínica exuberante

“…4 This predominance is also found in other dermatoses in which there is an abnormal response to ultraviolet radiation such as polymorphic light eruption and photosensitivity to drugs. 7 Some authors have reported lesions resembling actinic granuloma in unexposed areas, i.e. areas with no solar damage.…”

Annular Elastolytic Giant Cell Granuloma Successfully Treated with Minocycline Hydrochloride

“…However, minocycline should be used with care, as it may be associated with photosensitivity. This could potentially worsen, rather than improve AEGCG, as previously reported with doxycycline (12).…”

Phototoxicity of Doxycycline: A Systematic Review on Clinical Manifestations, Frequency, Cofactors, and Prevention

“…Also, photo-onycholysis is possible [5,6,7,8]. Lichenoid reaction and actinic granuloma were reported in only 1 case each [9,10]. …”

“…To determine the frequency or risk of phototoxic reactions in the course of a therapy with doxycycline is difficult because it depends on the geographical location of the country in which the patient stays, the patient's behavior referring to sun exposure, and also the sunscreen preparation used, if at all [10,13]. Moreover, the term “phototoxic reaction” is not consistently used in publications and varies from sunburn-like sensation with light erythema to heavy manifestation with large-area erythematous plaques.…”

“…A case reporting a lag time of 2 weeks between discontinuing of doxycycline and the beginning of onycholysis shows that symptoms may start with a considerable delay after sun exposure [8]. The phototoxic reaction may also lead to a lichenoid eruption with pink polygonal papules, with some confluence into plaques [9] or to actinic granulomata after months [10]. …”