« Back to Inflammatory Disorders

Granulomatous Diseases of the Skin

»	What is meant by “granulomatous diseases of the skin”?
»	Explain the role of histiocytes in granulomas.
»	What is the difference between an immune granuloma and a foreign body granuloma?
»	List some common granulomatous diseases that affect the skin.
»	Can granulomas be recognized clinically?
»	How do endogenous “foreign” bodies cause granulomas?
»	What are the sources of the exogenous foreign body agents?
»	Do cosmetic fillers ever produce foreign body granulomas?
»	Can the cause of a foreign body reaction be diagnosed histologically?
»	What is sarcoidosis?
»	How often is the skin involved in sarcoidosis?
»	Describe the specific cutaneous findings in sarcoidosis.
»	What is lupus pernio?
»	Describe the nonspecific cutaneous lesions of sarcoidosis.
»	Does sarcoidosis ever present in the skin without extracutaneous involvement?
»	What is Löfgren’s syndrome?
»	What is Heerfordt’s syndrome?
»	How should cutaneous sarcoidosis be treated?
»	What is the typical presentation of granuloma annulare?
»	Do any systemic associations occur with granuloma annulare?
»	What is the typical course of granuloma annulare?
»	How is granuloma annulare treated?
»	What is actinic granuloma?
»	Are rheumatoid nodules really a granulomatous disorder?
»	Where do rheumatoid nodules typically occur?
»	What causes rheumatoid nodules?
»	What is accelerated nodulosis?
»	Are rheumatoid nodules specific for rheumatoid arthritis?
»	Do patients with lupus miliaris disseminatus faciei have lupus erythematosus?

What is meant by “granulomatous diseases of the skin”?

Quite simply, the granulomatous disorders of the skin comprise a broad category of diseases that are characterized by the accumulation of activated macrophages with an epithelioid appearance in the dermis or subcutaneous tissue. A granuloma is a distinct aggregate composed of epithelioid macrophages with or without multinucleated giant cells. These aggregates are typically surrounded by a rim of lymphocytes with plasma cells being variably present. Macrophages develop from bone marrow–derived monocytes that leave the circulation and enter the skin.