Winkelmann Granuloma

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To the Editor:
The clinicopathologic study of 10 patients with interstitial granulomatous dermatitis described by Countinho et al1 provided an excellent review and discussion of this disease concept. I agree with the authors that there is significant overlap between the entities previously described as “palisaded neutrophilic granulomatous dermatitis” and “interstitial granulomatous dermatitis.” The authors also correctly note the consistent association of this process with systemic immunoreactive diseases, although none of their 10 cases had an underlying lymphoma or lymphoproliferative disorder, a finding described several times by others.2–4
Countinho et al credit Ackerman5 with the initial description of interstitial granulomatous dermatitis in 1993. Ackerman chose a different name for the process, but this histopathologic phenomenon was initially recognized and reported by Winkelmann. Countinho et al fail to give proper credit to Dicken and Winkelman6 for the first report in the medical literature of this entity in 1978, one and half decades before Ackerman's description and 16 years before the excellent review by Chu et al.7 In fact, Winkelmann in association with others had already published 4 articles on this entity2,3,6,8 before Ackerman's description of interstitial granulomatous dermatitis in 1993.
To recognize Winkelmann's contribution, it was proposed in 19964 that the unifying term “Winkelmann granuloma” be used to describe this distinct histopathologic entity, one disorder that has been described by at least 7 different and confusing nosologic terms, as alluded to by Countinho et al.1 Using the term Winkelmann granuloma would simplify the terminology and give credit to the dermatopathologist who recognized the importance of this finding many years before others.
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