»	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 are the sources of the exogenous foreign body agents?

Fig. 13.1 A, Typical graphite granuloma due to pencil lead injury. B, Skin-colored nodule due to yucca thorn embedded in the skin for several years.

See Table 13-2 and Fig. 13-1.

Table 13-2. Sources of Foreign Bodies
	AGENT	SOURCE
	Silicone	Breast implants, joint prostheses, soft tissue injections, hemodialysis tubing
	Silica	Soil and rock (very abundant), glass
	Paraffin (oils)	Cosmetic injection (historically), factitial injection, grease gun injury
	Starch	Surgical gloves contaminating wounds
	Graphite	Pencil lead (see Fig. 13-1A)
	Thorns	Roses, cactus, yucca (see Fig. 13-1B)
	Hair	Barbers, dog groomers, sheep shearers
	Talc	IV drug use, wound contamination
	Aluminum	Adjuvant in DPT immunizations
	Zirconium	Deodorant sticks
	Beryllium	Metal, ceramic, and electronic industries; fluorescent lamp workers (historically, as this ceased in 1951)

DPT, Diphtheria-pertussis-tetanus, IV, intravenous.