Archives of Dermatological Research

, Volume 259, Issue 3, pp 225–234 | Cite as

The ultrastructure of granuloma annulare

  • Helmut H. Wolff
  • Wojciech Maciejewski
Article

Summary

Nine cases of granuloma annulare at different stages of development were investigated electron microscopically. Special attention was given to collagen changes, to the cellular infiltrate, and to vascular changes. The necrobiotic changes of the collagen were: loosening of the fibers at the borders of the bundles; swelling and loss of cross-striation of the fibrils; and complete degradation of the collagen, with precipitation of mucinous and fibrin material and of glycogen. In 2 cases “cross-banded filamentous aggregations” were present. In later stages new collagen synthesis occurred. In the infiltrate, histiocytes/macrophages were seen developing into epithelioid and giant cells. In addition, numerous active lymphocytes and, at later stages, some neutrophils were found. Vascular changes consisted of endothelial swelling and duplications of the basal lamina. A perivascular infiltrate was present, but no distinct vasculitis was seen. Our results indicate that the necrobiosis of the collagen without primary vasculitis may be an initial event in granuloma annulare. A delayed hypersensitivity mechanism is discussed with regard to pathogenesis.

Key words

Granuloma annulare Necrobiosis of collagen Palisading granuloma Electron microscopy 

Zusammenfassung

Neun Fälle von Granuloma annulare in verschiedenen Entwicklungsstadien wurden elektronenmikroskopisch untersucht, insbesondere Kollagenveränderungen, das entzündliche Infiltrat und Gefäßalterationen. Die nekrobiotischen Veränderungen des Kollagens bestehen in Auflockerung der Bündel vom Rande her, Schwellung der Fibrillen mit Verlust ihrer Querstreifung, völliger Desintegration des Kollagens und Niederschlägen von mucinösen Substanzen, Fibrin und Glykogen. In 2 Fällen waren sogenannte “filamentöse quergestreifte Aggregationen” (= sog. “long-spacing collagen”) nachweisbar. In späteren Stadien zeigte sich Kollagenneubildung. Im Infiltrat sind vor allem Histiocyten/Makrophagen mit Übergängen zu Epitheloidzellen und Riesenzellen, daneben auch Lymphocyten und später Neutrophile identifizierbar. Gefäßveränderungen bestehen in Endothelschwellung und Basalmembranverdoppelungen. Es besteht ein perivasculäres Infiltrat, jedoch keine echte Vaskulitis. Die Ergebnisse sprechen dafür, daß die Nekrobiose des Kollagens ohne primäre Vaskulitis ein initiales Ereignis bei Granuloma annulare darstellt. Pathogenetisch wird ein Immungeschehen vom verzögerten Typ diskutiert.

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Copyright information

© Springer-Verlag 1977

Authors and Affiliations

  • Helmut H. Wolff
    • 1
  • Wojciech Maciejewski
    • 1
  1. 1.Dermatologische Klinik und PoliklinikUniversität MünchenMünchen 2Germany

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