Topiramate-induced reactive granulomatous dermatitis

The clinicopathologic spectrum of reactive granulomatous dermatitis (RGD) includes 4 subtypes: palisaded neutrophilic and granulomatous, interstitial granulomatous, polycyclic (granuloma annulare–like), and drug-induced reactive granulomatous dermatitis (diRGD).1 Granulomatous drug eruptions encompass the latter in addition to drug-induced variants of accelerated rheumatoid nodulosis, granuloma annulare (GA), sarcoidosis, and interstitial granulomatous drug reaction.1, 2, 3 Topiramate is an anticonvulsant drug used for migraine prophylaxis. We report a case of topiramate-induced RGD with clinical and histologic features that differentiate it from the recently reported topiramate-induced granuloma annulare.4, 5, 6