Busy Dermis
The Busy Dermis clue usually points to the interstitial type of granuloma annulare with associated damaged (necrobiotic) collagen but there are other granulomatous disorders such as interstial granulomatous dermatitis and interstitial granulomatous drug reactions to consider as well.
Rarer presentations include a subtle breast carcinoma recurrence, Desmoplastic melanoma and an early Kaposi's sarcoma.
Weedon also mentions looking for a folliculitis in deeper levels, a resolving vasculitis with mucin and sometimes a chronic photodermatosis.
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