Can granulomas be recognized clinically?

Sometimes. Granulomas usually present as dermal nodules, although epidermal changes can be present. Foreign body granulomas may demonstrate a central erosion or ulceration secondary to an attempt by the body to extrude the foreign material through an elimination tract. Granulomas often present as nonspecific erythematous nodules; however, they also may present as dermal nodules with an “apple-jelly hue” that is highly suggestive of an underlying granulomatous process. This apple-jelly hue can frequently be better appreciated by using diascopy (applying pressure to the lesion with a glass slide).