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Annular Elastolytic Granuloma: A Clinicopathologic Study of 15 Cases and a Literature Review
Chin-Yao Eric Wang, Ramon M. Pujol, Hei-Hwa Lee, W. P. Daniel Su
Dermatol Sinica 14: 51-64, 1996

Background: Annular elastolytic granuloma (AEG) is a cutaneous granuloma that can be misdiagnosed as granuloma annulare, necrobiosis lipoidica, sarcoidosis as well as other granulomas.Objective: To determine the clinicopathologic characteristics of annular elastolytic granuloma (AEG), and to discuss the etiopathogenesis and differential diagnosis.Methods: A retrospective clinical and histopathologic study in 15 patients with AEG.Results: The total patients ranged in age from 52 to 79 years (10 men and 5 women), with a mean age of 68 years. The extremities were the most common sites, followed by the trunk, face and neck. The lesions were either asymptomatic or itching. Most of the lesions grow very slowly, over a span of 6 months to 10 years prior to be examined. Patients had a broad clinical spectrum of lesions that histologically showed a picture of reticular dermal elastolysis and multinucleated giant cells with elastophagocytosis (or elastoclasis).Conclusion: We suggest that AEG is a distinctive clinicopathologic entity, but resulting from various processes which induce elastophagocytosis and giant cell granuloma. It may be associated with some systemic diseases. Not only the sun-exposed area but also the covered area of the skin is affected. There are some unknown mechanisms in AEG about its natural history and etiopathogenesis. Its differential diagnosis from other granuloma or elastolysis is challenging. We propose the following applicable criteria to establish a definite diagnosis of AEG:"AGREE with 5 NO"- annularity, granuloma, reticular dermis predominance, elastolysis, elastophagocytosis; no necrobiosis, no palisading process, no mucin production, no foreign body and no infectious micro-organisms.One sentence summary: Annular elastolytic granuloma (AEG) is studied and reviewed with emphasis on its probable etiopathogenesis, distinctive clinicopathologic features and differential diagnosis.

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