Perforating Granuloma Annulare

The granulomatous reaction pattern

“…Similar changes are present in septa of adipose tissue. 285 The lesions sometimes perforate by way of a hair follicle. 476 In active chronic lesions there is some variability between cases.…”

Multiple asymptomatic scrotal nodules

“…Perforating granuloma annulare (PGA) is a rare subtype of granuloma annulare (GA) which was first described by Owens and Freeman in 1971 as an unusual localized, papular, umbilicated variant of GA, showing transepidermal elimination of necrobiotic material 1 …”

“…Perforating granuloma annulare (PGA) is a rare subtype of granuloma annulare (GA) which was first described by Owens and Freeman in 1971 as an unusual localized, papular, umbilicated variant of GA, showing transepidermal elimination of necrobiotic material. 1 More common in young adults (mean age at onset 31 years) and with a female preponderance, PGA may present as asymptomatic or slightly pruritic crops of redcoloured papules, crusty, scaly papules, umbilicated papules, pustule-like papules, annular plaques or scars. The lesions may be localized to the upper limbs and palms or as in the more common generalized form, present on the abdomen, trunk and upper and lower limbs.…”

Necrobiotic granulomas

“…Usually, these areas show an increased amount of hyaluronic acid best demonstrated by special stains such as the colloidal-iron stain with and without predigestion with hyaluronic acid or tbe alcian-blue at pH 2.5 (20). In rare instances, transepidermal elimination of necrobiotic tissue results in perforation of the epidermis (6).…”