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Granulomatous Diseases of the Skin

»	What is meant by “granulomatous diseases of the skin”?
»	Explain the role of histiocytes in granulomas.
»	What is the difference between an immune granuloma and a foreign body granuloma?
»	List some common granulomatous diseases that affect the skin.
»	Can granulomas be recognized clinically?
»	How do endogenous “foreign” bodies cause granulomas?
»	What are the sources of the exogenous foreign body agents?
»	Do cosmetic fillers ever produce foreign body granulomas?
»	Can the cause of a foreign body reaction be diagnosed histologically?
»	What is sarcoidosis?
»	How often is the skin involved in sarcoidosis?
»	Describe the specific cutaneous findings in sarcoidosis.
»	What is lupus pernio?
»	Describe the nonspecific cutaneous lesions of sarcoidosis.
»	Does sarcoidosis ever present in the skin without extracutaneous involvement?
»	What is Löfgren’s syndrome?
»	What is Heerfordt’s syndrome?
»	How should cutaneous sarcoidosis be treated?
»	What is the typical presentation of granuloma annulare?
»	Do any systemic associations occur with granuloma annulare?
»	What is the typical course of granuloma annulare?
»	How is granuloma annulare treated?
»	What is actinic granuloma?
»	Are rheumatoid nodules really a granulomatous disorder?
»	Where do rheumatoid nodules typically occur?
»	What causes rheumatoid nodules?
»	What is accelerated nodulosis?
»	Are rheumatoid nodules specific for rheumatoid arthritis?
»	Do patients with lupus miliaris disseminatus faciei have lupus erythematosus?

What is accelerated nodulosis?

Accelerated nodulosis is the rapid onset of rheumatoid nodules that develops in a small subset of patients treated with methotrexate. The nodules typically regress following discontinuation of the methotrexate and recur with rechallenge. Although several theories have been proposed, the pathogenesis is not understood.

Williams FM, Cohen PR, Arnett FC: Accelerated cutaneous nodulosis during methotrexate therapy in a patient with rheumatoid arthritis, J Am Acad Dermatol 39:359–362, 1998.