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Granulomatous Diseases of the Skin

»What is meant by “granulomatous diseases of the skin”?
»Explain the role of histiocytes in granulomas.
»What is the difference between an immune granuloma and a foreign body granuloma?
»List some common granulomatous diseases that affect the skin.
»Can granulomas be recognized clinically?
»How do endogenous “foreign” bodies cause granulomas?
»What are the sources of the exogenous foreign body agents?
»Do cosmetic fillers ever produce foreign body granulomas?
»Can the cause of a foreign body reaction be diagnosed histologically?
»What is sarcoidosis?
»How often is the skin involved in sarcoidosis?
»Describe the specific cutaneous findings in sarcoidosis.
»What is lupus pernio?
»Describe the nonspecific cutaneous lesions of sarcoidosis.
»Does sarcoidosis ever present in the skin without extracutaneous involvement?
»What is Löfgren’s syndrome?
»What is Heerfordt’s syndrome?
»How should cutaneous sarcoidosis be treated?
»What is the typical presentation of granuloma annulare?
»Do any systemic associations occur with granuloma annulare?
»What is the typical course of granuloma annulare?
»How is granuloma annulare treated?
»What is actinic granuloma?
»Are rheumatoid nodules really a granulomatous disorder?
»Where do rheumatoid nodules typically occur?
»What causes rheumatoid nodules?
»What is accelerated nodulosis?
»Are rheumatoid nodules specific for rheumatoid arthritis?
»Do patients with lupus miliaris disseminatus faciei have lupus erythematosus?

 
 
 

What is the difference between an immune granuloma and a foreign body granuloma?

Immune granuloma formation is a local tissue response to a poorly soluble substance that is capable of inducing a cellmediated immune response (e.g., cutaneous tuberculosis). The persistent presence of a poorly soluble substance in the skin causes the activation of T cells, which secrete cytokines such as interleukin-2 (Il-2) to activate additional T cells and interferon-2 (IFN-2), which transform macrophages into epithelioid macrophages and multinucleated giant cells. In contrast, foreign body granulomas, typically are the result of larger aggregates of inert foreign material that cannot be phagocytized by a single macrophage (e.g., wood splinter). In general, granulomas are produced by infectious agents, foreign bodies, or alterations in the host immune system.