The skin biopsy specimen revealed palisaded granulomatous inflammation in the dermis, with central hypocellular collagen. Elastotic material was present in giant cells. Verhoeff–van Gieson staining revealed decreased elastic fibers in the center of the palisaded granuloma. No vascular changes were seen.
After the diagnosis of AEGCG was made, the patient was treated with 4 months of hydroxychloroquine sulfate, with tacrolimus gel subsequently added to the regimen. There was a noted decrease in peripheral erythema of the raised borders and a mild improvement in the central areas of hypopigmentation. Centrally located lesional dermal atrophy remained.
Annular Atrophic Plaques on the Arms of a 57-Year-Old Woman—Diagnosis. Arch Dermatol. 2006;142(6):775-780. doi:10.1001/archderm.142.6.775-e