Actinic granuloma-like change in exogenous ochronosis: case report

Exogenous ochronosis is caused by the longterm application of skin-lightening creams containing hydroquinone. This irreversible disfiguring cosmetic problem assumes epidemic proportions in South African blacks. Mild ochronosis is characterized clinically by coarsening and darkening of the skin and severe ochronosis by coalescing, caviar-like black papules and atrophy. Histology shows ochronotic collagen fibres with eventual formation of ochronotic colloid milium. A variable cellular infiltrate, which may be granulomatous, is present. We describe a 39-year-old black woman with severe exogenous ochronosis who developed superimposed annular lesions with granulomatous histology bearing great resemblance to lesions of actinic granuloma.