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Granulomatous Reaction Pattern of the Skin                    

Dr Sampurna Roy MD        




A granulomatous reaction pattern is defined as a dermal chronic inflammatory pattern in which granulomas are present.

Granulomas are organised well formed discrete collection of histiocytes or epithelioid cells together with variable numbers of multinucleated giant cells and other inflammatory cells.


1. Sarcoidal:


Granulomas ('naked' granulomas) are composed of epithelioid histiocytes and multinucleated giant cells with only sparse infiltrate of lymphocytes and plasma cells at the periphery.

Visit related posts:

Cutaneous Sarcoidosis ; 

Reaction to foreign material. 

2. Tuberculoid:


Confluent granulomas composed of epithelioid histiocytes, giant cells (Langhans and foreign body type), and prominent mononuclear infiltrate (lymphocytes and plasma cells) surrounding the granuloma.

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Tuberculosis (Lupus Vulgaris)

Leprosy ;

Late Syphilis

Leishmaniasis  ;

Pathology Quiz Case 52  ;  

Rosacea ;

Crohn's disease .


3. Suppurative:


Granulomas are composed of epithelioid cells, with or without multinucleated giant cells, central collections of neutrophils and chronic inflammatory cells in the periphery.

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Chromomycosis/phaeohypomycosis ;


Mycobacterium marinum infection ;



Mycetoma ;

Nocardiosis ;


Cat Scratch Disease;



4. Necrobiotic: 


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Granuloma annulare;

Necrobiosis lipoidica ;

Pathology Quiz Case 55 ;

Rheumatoid nodule

Pathology Quiz Case 53 ;

Pseudorheumatoid nodule (deep granuloma annulare) ;

Pathology Quiz Case 54 ;

Necrobiotic xanthogranuloma.


5. Foreign Body Type:  (Exogenous material and Endogenous material )


Foreign body type granulomas are characterized by identifiable foreign material together with epithelioid cells, multinucleated foreign body giant cells and inflammatory cells.


6. Misellaneous Granulomas:

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Melkersson Rosenthal Syndrome ;

Annular Elastolytic Giant Cell Granuloma ;            

Interstitial Granulomatous Dermatitis ;

Interstitial Granulomatous Drug Reaction.



Related Links:

Granulomatous lesions ( Dr Yale Cohen)

Further reading:

Crohn's disease: an important differential diagnosis of granulomatous skin diseases.

A Case of Foreign-Body Granuloma of the Glabella due to Polyacrylamide Filler and an Intractable Ulcer after Skin Biopsy: An Immunohistochemical Evaluation of Inflammatory Changes.

Fish tank granuloma caused by Mycobacterium marinum.

Expression of Notch Signaling Components in Cutaneous Foreign Body and Sarcoidal Granulomas and Fusing Macrophages.

Granulomatous skin lesions, severe scrotal and lower limb edema due to mycobacterial infections in a child with complete IFN-γ receptor-1 deficiency.

Cutaneous leishmaniasis with histopathologic pattern of non-necrotizing granulomatous dermatitis in patients treated with adalimumab.

Chromoblastomycosis in Kerala, India.

Histopathological spectrum of cutaneous tuberculosis and non-tuberculous mycobacterial infections.





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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