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July 1980

Erythematous Generalized Granuloma Annulare

Author Affiliations

Auburn, Mass

Arch Dermatol. 1980;116(7):750-751. doi:10.1001/archderm.1980.01640310020007

To the Editor.—  I read with great interest the report by Eng1 on erythematous generalized granuloma annulare. Both patients had pulmonary emphysema, and one had noted the onset of her dermatosis after a sunburn. The results of elastic tissue stains were not noted.It is well known that some patients with emphysema have a genetic deficiency of α1-antitrypsin, the major human leukocyte elastase inhibitor.2In 1975, O'Brien3 popularized the concept of actinic granuloma, a granuloma-annulare-like dermatosis in a sun-exposed distribution. Histologically, actinic elastosis was absent inside an annular lesion but present outside it. The granulomatous infiltrate in the anulus showed histiocytes containing elastic material. The author views actinic granuloma as a specific entity that is a response to actinically damaged elastic tissue.3 O'Brien has more recently extended his concept to include temporal arteritis. He found more severe granuloma

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