# Two Decades With Chronic Actinic Granuloma: A Case Report

## TL;DR

This paper reports a 20-year case of a rare skin condition called actinic granuloma that did not respond to standard treatments.

## Contribution

The novelty lies in documenting a long-term, treatment-resistant case of actinic granuloma to raise awareness and improve disease management.

## Key findings

- The patient's AG did not respond to topical steroids or antifungals over 20 years.
- AG remains a poorly understood condition with inconsistent treatment outcomes.
- Long-term case reports can aid in better understanding and managing AG.

## Abstract

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.