Palisaded Granulomatous Dermatoses
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This document discusses several types of palisaded granulomatous dermatoses including granuloma annulare (GA), annular elastolytic giant cell granuloma, and actinic granuloma. It provides information on the presentation, associations, and treatments for localized and generalized GA. It also includes photographs and descriptions of GA lesions on the hands. Treatment options discussed include topical steroids for localized GA and tetracycline combined with nicotinamide or PUVA for generalized GA.
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Palisaded Granulomatous Dermatoses
- 1. Palisaded Granulomatous Dermatoses • GA • Annular Elastolytic Giant Cell Granuloma and Actinic Granuloma • Granuloma Multiforme • Interstitial Granulomatous Drug Rxn • Necrobiotic Xanthogranuloma
- 3. GA • Localized • Generalized • Patch-type or Macular • Subcutaneous • Perforating • In HIV disease • And Malignant Neoplasms
- 4. Matching • *Women 5th and 6th decade • Young boys • Children and young to middle aged • Hands, feet, elbows and ankles • Upper medial thighs • Distal extremities or scalp • *Papule dorsal hands with central keratotic core • Assoc sun exposure • Assoc autoimmune thyroiditis • Assoc trauma • Pseudorheumatoid nodule 1. Localized 2. Generalized 3. Patch-type or Macular 4. Subcutaneous 5. Perforating 6. In HIV disease 7. And Malignant Neoplasms
- 7. Treatment • What are treatments for localized GA? – Do nothing – IL TAC – Topical steroids or tacrolimus • What are treatments for generalized GA? – Tetracycline 500mg bid + nicotinamide 500mg tid – Tetracycline 500mg bid +PUVA – Dapsone, pentoxifylline, potassium iodide SSKI, cyclosporin, UVA1, defibrotide, tranilast, antimalarials
- 8. Generalized granuloma annulare treated with short-term administration of etretinate. JAm Acad Dermatol. 2006 May;54(5 Suppl):S245-7. Asano Y, Saito A, Idezuki T, Igarashi A.
- 10. Matching • Central Africa • Blindness • *Sun damaged skin • Meischer’s • Leiker • O’Brien • IgG paraproteinemia • assoc temporal arteritis • Assoc CCB • Deep dermal perivascular and interstitial infiltrate of neutr, eos, histiocytes and giant cells surrounding degenerated collagen • atrophic yellow thin plaque forehead • *interstitial giant cells & macrophages with elastophagocytosis, decreased elastic tissue 1. Annular Elastolytic Giant Cell Granuloma 2. Actinic Granuloma 3. Granuloma Multiforme 4. Interstitial Granulomatous Drug Rxn 5. Necrobiotic Xanthogranuloma
- 12. Som.tulane.edu
- 13. Photograph by Victoria Nguyen, MD (me!)
- 14. Som.tulane.edu
- 19. Sarcoidosis • In the US, which race is sarcoidosis most prevalent in? – African-Americans • In African-Americans, compared to Caucasians, do you see more specific or nonspecific cutaneous lesions? – Specific 50% compared • What is the pediatric sarcoidosis early triad? – Skin lesions – Uveitis – Arthritis
- 20. Matching • **African Americans • ****Systemic disease • nonspecific • Hilar adenopathy • Rhinophyma-like • *Elevated ESR • Elevated ACE • *Bone cysts • Infiltration of tattoos • Chronic pulmonary fibrosis 1. Papular sarcoid 2. Annular sarcoidosis 3. Hypopigmented sarcoidosis 4. Lupus pernio 5. Ulcerative sarcoidosis 6. Subcutaneous sarcoidosis 7. Sarcoidosis in scars 8. Plaques 9. Erythrodermic sarcoidosis 10. Ichthyosiform sarcoidosis 11. Alopecia 12. Morpheaform sarcoidsois 13. Mucosal sarcoidosis 14. Erythema nodosum in sarcoidosis 15. Systemic sarcoidosis
- 21. More Matching • Good prognosis • **Head and neck • **Primarily Legs • Miliary sarcoid • Uveo-parotid fever/Heerfordt syndrome • Darier-Roussy • Mikulicz syndrome • Lofgren syndrome • Uhthoff phenomenon 1. Papular sarcoid 2. Annular sarcoidosis 3. Hypopigmented sarcoidosis 4. Lupus pernio 5. Ulcerative sarcoidosis 6. Subcutaneous sarcoidosis 7. Sarcoidosis in scars 8. Plaques 9. Erythrodermic sarcoidosis 10. Ichthyosiform sarcoidosis 11. Alopecia 12. Morpheaform sarcoidsois 13. Mucosal sarcoidosis 14. Erythema nodosum in sarcoidosis 15. Systemic sarcoidosis
- 22. Sarcoidosis • Which cytokine polymorphisms are associated with sarcoidosis? – TNF-alpha – IFN-alpha – IL-12
- 27. Diagnosis Sarcoidosis • How do you establish the dx of sarcoidosis? – Demonstrate two organ systems: – Cutaneous – Pulmonary – Ophthalmologic – Salivary glands
- 28. Sarcoidosis and Immunologic Abnormalities • Which immunologic abnormalities are associated with sarcoidosis? – Hodgkin’s lymphoma – IFN-alpha therapy – Hep C – HAART – Hematopoetic stem cell transplantation
- 29. Which of the following is not a treatment for cutaneous sarcoidosis? a. Systemic corticosteroids b. IL kenalog c. Doxycycline d. Hydroxychloroquine e. Methotrexate f. Isotretinoin g. Interferon h. Thalidomide i. Etanercept
- 31. Non-X Histiocytoses • Juvenile Xanthogranuloma • Benign Cephalic Histiocytosis • Generalized Eruptive Histiocytoma • Xanthoma Disseminatum (Montgomery syndrome) • Progressive Nodular Histiocytosis • Papular Xanthoma • Hereditary Progressive Mucinous Histiocytosis in Women • Reticulohistiocytosis • Intermediate Cell Histiocytosis • Sea-Blue Histiocytosis
- 33. Which of the following is not true of JXG? a. Extracutaneous sites include lung, liver, and testis b. Extracutaneous JXG is uncommon, presenting in 5% of multiple cutaneous cases c. Children with JXG should be examined for stigmata for NF-1 and if found the pediatrician should be alerted of possible JCML d. JXG is a proliferation of dermal dendrocytes, in contrast to LCH which is a proliferation of langerhans cells e. Children with multiple JXG under 3 yrs need ocular screening
- 37. JXG • In what age group is this found? – 5-17% birth – 40-70% 1st yr of life – Adults • What are the three forms? – Small nodular (2-5mm) – Large nodular (5-20mm) – Giant (>20mm)
- 39. Which of the following statements regarding multicentric reticulohistiocytosis is false? a. Multisystem disease begins age 50 b. Hand and finger involvement is the most common with classic “coral bead” appearance c. Nodules over joints can resemble rheumatoid nodules d. Associated arthropathy is inflammatory, symmetrical polyarticular arthritis and can be confused with rheumatoid or psoriatic arthritis e. Treatment should be geared to cutaneous lesions, not arthritis f. Should screen for malignancy, TB and myocardial involvement
- 42. Matching: Other Non-X Histiocytoses • foamy scalloped macrophages • S100 and CD1a positive • Leonine facies • *Visceral involvement • Giemsa and May- Gruenwald positive • Abundant mucin • Benign Cephalic Histiocytosis • Generalized Eruptive Histiocytoma • Xanthoma Disseminatum (Montgomery syndrome) • Progressive Nodular Histiocytosis • Papular Xanthoma • Hereditary Progressive Mucinous Histiocytosis in Women • Intermediate Cell Histiocytosis • Sea-Blue Histiocytosis
- 44. What distinguishes Non-X histiocytoses from X-type histiocytoses? • Langerhans cells present in X-type • Monocyte/macrophages infiltrates in non-X type
- 45. X-type Histiocytoses • Congenital Self-Healing Reticulohistiocytosis (Hashimoto-Pritzker) • Langerhans Cell Histiocytosis (Histiocytosis X)
- 49. Dental.mu.edu
- 50. Dental.mu.edu
- 52. Which statement regarding LCH is false? a. Localized LCH is more common in children and multisystem in adults b. Associated ALL and AML have occurred in LCH pts c. Visceral involvement includes bone, LN, bone marrow, liver, and lungs d. Endocrine dysfxn is in form of diabetes mellitus e. In multisystem disease of childhood, vinblastine and corticosteroids are the standard
- 57. Alta Dermatology Victoria Nguyen Wang, MD 27882 Forbes RD Suite 201 Laguna Nigel, CA 92677 (949) 364-9264