Granulomatous pigmented purpuric dermatosis (GPPD) is a rare entity with few cases reported in the literature. We report 3 cases of pigmented purpuric dermatosis (PPD) with granulomatous features in a 9-year-old boy, a 49-year-old woman, and a 75-year-old woman. We also review the literature on PPDs with granulomatous features, including histopathologic features and disease associations. Most of the cases we reviewed described granulomas superimposed on classic changes of PPD. We also identify a new variant of GPPD in 2 of our patients who presented with granulomatous infiltrates in the mid to deep dermis. Granulomatous PPD does not appear to have a consistent association with underlying disease; notably, hyperlipidemia was seen in 7 cases we reviewed.
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