Deep Granuloma Annulare

Chalazia are very common. The clinical presentation is usually very typical, with an acute swelling in the tar-sal conjunctiva. In a few days the swelling becomes a firm nodule. Excision or excochleation is the treatment of choice. Because of the typical clinical presentation, many ophthalmologists will not offer the material for routine histological examination. Chalazia are caused by the obstruction of the duct of a small (Zeis) or larger (Meibomian) sebaceous gland. A small retention cyst is formed and rupture of this cyst causes the escape of fatty products into the surrounding tissues. The fatty material triggers an acute inflammatory reaction first, followed by a chronic granulomatous reaction (Fig. 10.28). In the very late stages of chalazia, fibrosis and scarring can be seen. The presence of fatty cells or even larger optical empty spaces within a granulomatous reaction is characteristic of a chalazion. The only other conditions with similar lipogranulomatous reactions are leakage of

Granuloma annulare usually occurs on the dorsum of the hands and the lower arms. It is considered to be a cutaneous reaction pattern, most frequently associated with diabetes mellitus. However, in children the deep variant of granuloma annulare is a benign, relatively common dermatosis, not related to systemic disease. In granuloma annulare of childhood lesions typically occur on the extremities and resolve spontaneously over a period of several months to years. Localised facial involvement, sometimes with involvement of the eyelids, is rare. The clinical relevance is that granuloma annulare, presenting in the periocular region, may mimic other lesions. This diagnosis should be considered for any acquired papules of the periorbital area, especially if there is a history of antecedent trauma. Unnecessary surgical excision can then be avoided. Histology shows deep foci of degeneration of collagen, surrounded by histiocytes. Often there is increased dermal mucin.

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