Granulomatous Lesions of Skin in a Tertiary Care Hospital Over a 1-year Period

Abstract Background: Cutaneous granulomatous lesions are a heterogeneous group of disorders with skin inflammatory reaction which is caused by a wide variety of agents including infectious, foreign bodies, malignancies, metabolites, and chemicals. Granulomas are a type of type IV hypersensitivity reactions due to by poorly soluble reactive substances characterized by a focal collection of epithelioid cells, histiocytes mixed with variable number of lymphocytes and sometimes giant cells. They are a common skin pathology, often needing histopathological confirmation for diagnosis. The incidence and prevalence of different types of granulomatous lesions of skin depends on the geographic location. Granulomatous skin lesions can be histologically classified broadly into either necrotizing and non-necrotizing patterns. Histologically, six major subtypes of granulomas are found in granulomatous skin diseases – tuberculoid, sarcoidal, necrobiotic, suppurative, foreign body, and histoid/histiocytic type. Materials and Methods: This was a retrospective analysis of lesions labeled as granulomatous lesions. Skin biopsies received in the Department of Pathology, INHS Asvini,from January 2014 to December 2015 were studied. Detailed clinical and histopathological features were analyzed, and granulomatous skin lesions were categorized according to type of granuloma and etiology. Results: One hundred and thirty-six skin biopsies of granulomatous lesions were received, of which tuberculoid granulomas were the most common (67.4%), and the most common etiology of granulomas inthe study was leprosy. Other etiologies were cutaneous tuberculosis, foreign body granulomas, fungal lesions, sarcoidosis, and granuloma annulare. Conclusion: The aims of the present study were clinicopathological evaluation of granulomatous skin lesions and their etiological classification based on histopathological examination.Many granulomatous lesions of skin have similar histomorphology findings and conversely a single aetiology can produce a spectrum of histological features leading to diagnostic confusion among dermatologists and Pathologists. To treat these lesions, definitive diagnosis by the demonstration of the etiological agent is essential, which will bear an impact on the patient management and outcome.