Actinic granuloma presents as papules and plaques on sun-exposed skin. Lesions are usually numerous and may coalesce to form plaques that may cover much of the exposed skin. It may be pruritic, persistent, and is more common in older patients. Strangely, there is an association with temporal arteritis. Although it may in some instances appear like granuloma annulare, the histopathology of the two entities is very different. It can be differentiated from PMLE by the character of the lesions (firmer and often yellow red) and by the history, which would be a seasonal presentation, as we discussed previously. The above picture is a detail from the same patient in the original picture.