{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T17:09:16Z","timestamp":1767373756685,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dermatopathology"],"abstract":"<jats:p>A 71-year-old Caucasian woman presented with lesions on both elbows. A physical examination revealed arcuate plaques with raised erythematous edges and central clearing. Comedones and cysts were evident on the border of the lesions. The dermatoscopic view showed the presence of pores, in addition to granuloma annulare changes. The biopsies showed changes according to granuloma annulare, but the granulomas were closely related to comedones and cysts. Furthermore, the presence of elastophagocytosis via multinucleated Langhans-type giant cells was evident. Verhoeff\u2013van Gieson staining highlighted the transepithelial elimination of elastic fibers in the bottom of some cysts. The presence of comedones or cysts is exceptional in granuloma annulare. Only four similar cases have been reported. Although all previous cases showed lesions in sun-exposed areas over photodamaged skin, only our case showed transepithelial elimination of elastic fibers. Diabetes mellitus (DM) could play a role in the pathogenesis of this variant of actinic granuloma annulare, because most cases are associated with uncontrolled DM and the lesions improve after DM is controlled.<\/jats:p>","DOI":"10.3390\/dermatopathology12020016","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T04:27:58Z","timestamp":1748579278000},"page":"16","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Perforating Granuloma Annulare with Cysts and Comedones"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7174-8487","authenticated-orcid":false,"given":"Enric","family":"Piqu\u00e9-Duran","sequence":"first","affiliation":[{"name":"Dermatology Department, Dr Jos\u00e9 Molina Orosa Hospital, 35500 Arrecife, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikel","family":"Azcue-Mayorga","sequence":"additional","affiliation":[{"name":"Pathology Department, Dr Jos\u00e9 Molina Orosa Hospital, 35500 Arrecife, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belinda","family":"Roque-Quintana","sequence":"additional","affiliation":[{"name":"Dermatology Department, Dr Jos\u00e9 Molina Orosa Hospital, 35500 Arrecife, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Odalys","family":"Garc\u00eda-V\u00e1zquez","sequence":"additional","affiliation":[{"name":"Pathology Department, Dr Jos\u00e9 Molina Orosa Hospital, 35500 Arrecife, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Ruedas-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Dermatology Department, Dr Jos\u00e9 Molina Orosa Hospital, 35500 Arrecife, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.jaad.2015.03.055","article-title":"Granuloma annulare: Pathogenesis, disease associations and triggers, and therapeutic options","volume":"75","author":"Piette","year":"2016","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.jaad.2015.03.054","article-title":"Granuloma annulare: Clinical and histologic variants, epidemiology, and genetics","volume":"75","author":"Piette","year":"2016","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s40257-021-00636-1","article-title":"Granuloma annulare: An updated review of epidemiology, pathogenesis and treatment options","volume":"23","author":"Joshi","year":"2022","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/s004030000150","article-title":"Expression of IFNgamma, coexpression of TNFalpha and matrix metalloproteinases and apoptosis of T lymphocytes and macrophages in granuloma annulare","volume":"292","author":"Fayyazi","year":"2000","journal-title":"Arch. Dermatol. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jaad.2019.12.028","article-title":"Granuloma annulare profile shos activation of T-helper cell type 1, T-helper type 2 and Janus Kinasa pathways","volume":"83","author":"Min","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1001\/jamadermatol.2019.2130","article-title":"Refractory Generalized Granuloma Annulare Treated with Oral Apremilast","volume":"155","author":"Bishnoi","year":"2019","journal-title":"JAMA Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Joshi, T.P., and Tschen, J. (2021). Apremilast in the Management of Disseminated Granuloma Annulare. Cureus, 13.","DOI":"10.7759\/cureus.14918"},{"key":"ref_8","first-page":"1","article-title":"Recalcitrant generalized granuloma annulare treated successfully with dupilumab","volume":"7","author":"Song","year":"2021","journal-title":"J. Am. Acad. Dermatol. Case Rep."},{"key":"ref_9","first-page":"3","article-title":"Tildrakizumab ineffective in generalized granuloma annulare","volume":"7","author":"Song","year":"2021","journal-title":"J. Am. Acad. Dermatol. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1016\/j.jaci.2020.10.012","article-title":"Treatment of granuloma annulare and supression of proinflammatory cytokine activity with tofacitinib","volume":"147","author":"Wang","year":"2021","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1097\/DAD.0000000000000722","article-title":"Palisaded Granuloma on the Nose: An Atypical Presentation of Granuloma Annulare","volume":"39","year":"2017","journal-title":"Am. J. Dermatopathol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1097\/DAD.0b013e3181e8b4c3","article-title":"Granuloma annulare of the penis: A uncommon location for an usual disease","volume":"33","author":"Aliste","year":"2011","journal-title":"Am. J. Dermatopathol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"314","DOI":"10.4103\/ijdvl.IJDVL_24_18","article-title":"Linear granuloma annulare localized to the finger","volume":"86","author":"Gu","year":"2020","journal-title":"Indian J. Dermatol. Venereol. Leprol."},{"key":"ref_14","first-page":"S126","article-title":"A Case of Atypical Granuloma Annulare Presenting as Palmoplantar Pustules","volume":"35","author":"Kim","year":"2023","journal-title":"Ann. Dermatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e683","DOI":"10.1111\/jdv.19844","article-title":"Acute onset painful acral granuloma annulare: A new ulcerative variant","volume":"38","author":"Dhattarwal","year":"2024","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1111\/1346-8138.13432","article-title":"Case of disseminated granuloma annulare with giant plaques","volume":"43","author":"Saigusa","year":"2016","journal-title":"J. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/j.ad.2022.05.041","article-title":"Generalized Papular Granuloma Annulare Presenting with Pseudoxanthoma Elasticum-Like Lesions","volume":"114","author":"Calado","year":"2023","journal-title":"Actas Dermosifiliogr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"38","DOI":"10.3390\/dermatopathology7020006","article-title":"Pseudolymphomatous Granuloma Annulare: A Case Report","volume":"7","author":"Ibrahim","year":"2020","journal-title":"Dermatopathology"},{"key":"ref_19","first-page":"162","article-title":"Pseudolymphomatous Granuloma Annulare: A Little-Known Variant","volume":"110","author":"Fraga","year":"2019","journal-title":"Actas Dermosifiliogr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1097\/DAD.0000000000001156","article-title":"Keratoacanthomatous Changes: Unifying the Histologic Spectrum of Actinic Granuloma","volume":"40","author":"Harb","year":"2018","journal-title":"Am. J. Dermatopathol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Skrade, A.E., Pitchford, C.A., Neill, B.C., Chisholm, C., and Tolkachjov, S.N. (2022). Granuloma Annulare Mimicking Squamous Cell Carcinoma. Cureus, 14.","DOI":"10.7759\/cureus.27372"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1001\/archderm.1975.01630160050003","article-title":"Actinic granuloma","volume":"111","year":"1975","journal-title":"Arch. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00000372-197901010-00006","article-title":"Is actinic granuloma a specific condition?","volume":"1","author":"Ragaz","year":"1979","journal-title":"Am. J. Dermatopathol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1111\/cup.12292","article-title":"Evolution of granuloma annulare to mid-dermal elastolysis: Report of a case and review of the literature","volume":"41","author":"Lai","year":"2014","journal-title":"J. Cutan. Pathol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e209","DOI":"10.1111\/1346-8138.17116","article-title":"Anetoderma: Unusual clinical presentation of granuloma annulare","volume":"51","author":"Schafer","year":"2024","journal-title":"J. Dermatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1111\/j.1600-0781.2006.00230.x","article-title":"Open comedones overlying granuloma annulare in a photoexposed area","volume":"22","author":"Sudy","year":"2006","journal-title":"Photodermatol. Photoimmunol. Photomed."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/j.1365-2230.2011.04025.x","article-title":"Generalized granuloma annulare with open comedones in photoexposed areas","volume":"36","author":"Bhushan","year":"2011","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1097\/DAD.0000000000000841","article-title":"Actinic granuloma annulare with scarring and open comedones","volume":"39","author":"Gavioli","year":"2017","journal-title":"Am. J. Dermatopathol."},{"key":"ref_29","first-page":"25","article-title":"Chronic annular plaques with new peripheral folicular plugging","volume":"49","author":"Pensler","year":"2024","journal-title":"J. Am. Acad. Dermtol. Case Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e66","DOI":"10.1111\/1346-8138.14539","article-title":"Dermatoscopy in annular elastolytic giant cell granuloma","volume":"46","author":"Errichetti","year":"2019","journal-title":"J. Dermatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1001\/archderm.1997.03890420081009","article-title":"The histopathology of closed and open comedones of Favre-Racouchout disease","volume":"133","author":"Requena","year":"1997","journal-title":"Arch. Dermatol."},{"key":"ref_32","unstructured":"Kerl, H., Cerroni, L., Kokol, R., Requena, L., Kutzner, H., Metze, D., Fried, I., Stieber, W., and Wolf, I.H. (2018). Drug eruptions. Diagnostic Cutaneous Pathology: Clinical-Pathological Correlation of Inflammatory and Other Non-Neoplastic Skin Diseases: A Textbook and Atlas, Verlagshaus Jakomini. [1st ed.]."},{"key":"ref_33","unstructured":"Kerl, H., Cerroni, L., Kokol, R., Requena, L., Kutzner, H., Metze, D., Fried, I., Stieber, W., and Wolf, I.H. (2018). Mycobacterial infections, atypical. Diagnostic Cutaneous Pathology: Clinical-Pathological Correlation of Inflammatory and Other Non-Neoplastic Skin Diseases: A Textbook and Atlas, Verlagshaus Jakomini. [1st ed.]."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1111\/ijd.16969","article-title":"Dermatology practice updates in mycobacterial disease","volume":"63","author":"Barker","year":"2024","journal-title":"Int. J. Dermatol."},{"key":"ref_35","unstructured":"Kerl, H., Cerroni, L., Kokol, R., Requena, L., Kutzner, H., Metze, D., Fried, I., Stieber, W., and Wolf, I.H. (2018). Tuberculosis. Diagnostic Cutaneous Pathology: Clinical-Pathological Correlation of Inflammatory and Other Non-Neoplastic Skin Diseases: A Textbook and Atlas, Verlagshaus Jakomini. [1st ed.]."}],"container-title":["Dermatopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2296-3529\/12\/2\/16\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:43:22Z","timestamp":1760031802000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2296-3529\/12\/2\/16"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,29]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["dermatopathology12020016"],"URL":"https:\/\/doi.org\/10.3390\/dermatopathology12020016","relation":{},"ISSN":["2296-3529"],"issn-type":[{"type":"electronic","value":"2296-3529"}],"subject":[],"published":{"date-parts":[[2025,5,29]]}}}