Two Decades With Chronic Actinic Granuloma: A Case Report

Actinic granuloma (AG), also known as O'Brien's granuloma, is a rare idiopathic granulomatous dermatosis affecting sun-exposed areas, predominantly in older individuals. It presents as erythematous papules that expand into annular plaques with central atrophy and serpiginous borders. The pathogenesis of AG remains unclear, but it is hypothesized to involve an autoimmune response to actinically damaged elastic fibers. Diagnosis is confirmed through histopathological examination, and treatment options vary widely with inconsistent outcomes. Here, we present a case of an individual with a 20-year history of AG that was refractory to treatment with topical steroids and topical antifungals. This case highlights the need for heightened awareness surrounding this condition in order to help patients better manage this disease.