Clinical Atlas of Granulomatous Disorders




Key points







  • •

    Granulomatous disorders present with unique clinical morphologies.


  • •

    Visual recognition of granulomatous disorders is an important skill to be developed by the Health care provider.


  • •

    Visual recognition should be confirmed with histopathological evaluation.




Because dermatologists are classically visual learners and trained with many Kodachrome (now digital image) teaching sessions during residency and at continuing medical education conferences, I thought adding digital images would be ideal. Therefore, to further the reader’s experience with granulomatous disorders that were reviewed in great detail in this issue of Dermatology Clinics , I have added a “Clinical Atlas of Granulomatous Disorder” from cases that I have encountered over my career. I initially intended to include dermatopathology, but being a clinician-educator I wanted to focus on the unique clinical morphologies that these diseases present. However, with that being stated, dermatopathology plays a crucial role in differentiating these entities (ie, the best example is mucin staining to differentiate granuloma annulare from all other palisading granulomas). As one can tell, some images are scanned Kodachromes as my career has evolved from Kodak film to .jpg images, so I apologize for some horizontal lines in a few images. I want to thank all the patients that allowed me to image their skin disease and all the past, present, and future residents and colleagues who have and will work tirelessly in managing these patients with me. I hope you enjoy this collection as much as I enjoyed putting this section together for you.




Fig. 1


Granuloma annulare – macular.



Fig. 2


Granuloma annulare – macular.



Fig. 3


Granuloma annulare – Fig. 2 lesion resolved with punch biopsy.



Fig. 4


Granuloma annulare – localized papular.



Fig. 5


Granuloma annulare – disseminated.



Fig. 6


Granuloma annulare – subcutaneous.



Fig. 7


Granuloma annulare – subcutaneous and macular.



Fig. 8


Granuloma annulare – necrobiosis lipoidica/sarcodosis-like.



Fig. 9


Granuloma annulare – atypical.



Fig. 10


Granuloma annulare – atypical.



Fig. 11


Granuloma annulare – atypical zosteriform.



Fig. 12


Granuloma annulare – atypical zosteriform (arm of patient in Fig. 11).



Fig. 13


Granuloma annulare – atypical unilateral leg.



Fig. 14


Granuloma annulare – atypical unilateral leg and perforating (up close image of Fig. 13).



Fig. 15


Granuloma annulare – palmar.



Fig. 16


Granuloma annulare – palmar.



Fig. 17


Elastolytic actinic giant cell granuloma.



Fig. 18


Elastolytic actinic giant cell granuloma (elbow of patient in Fig.17).



Fig. 19


Necrobiosis lipoidica – early stage.



Fig. 20


Necrobisos lipoidica – early stage.



Fig. 21


Necrobiosis lipoidica – early stage (xanthomatous).



Fig. 22


Necrobiosis lipoidica – early stage (xanthomatous and up close image of Fig. 21).



Fig. 23


Necrobiosis lipoidica – middle stage (xanthomatous).



Fig. 24


Necrobiosis lipoidica – late stage (xanthomatous).



Fig. 25


Necrobiosis lipoidica – late stage (sclerotic).



Fig. 26


Necrobiosis lipoidica – late stage (sclerotic).



Fig. 28


Necrobiosis lipoidica – ulcerative.



Fig. 27


Necrobiosis lipoidica – upper extremity.



Fig. 29


Rheumatoid nodules – with coexisting rheumatoid vasculitis.



Fig. 30


Rheumatoid nodule – massive.



Fig. 31


Rheumatoid nodules – ulcerating.



Fig. 32


Accelerated rheumatoid nodulosis – methotrexate induced.



Fig. 33


Reactive granulomatous dermatitis – interstitial granulomatous dermatitis type.

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Feb 12, 2018 | Posted by in Dermatology | Comments Off on Clinical Atlas of Granulomatous Disorders

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