Evidence is presented that actinic granuloma is not a specific connective tissue disorder as it is thought to be by O'Brien. Granulomatous inflammation does not result simply from a response to elastotic fibers, but is a consequence of primary pathologic processes that are unrelated to damaged elastotic material. Twenty-one of 30 lesions in our series that fulfill O'Brien's criteria of his concept of actinic granuloma were clinically and histologically examples of granuloma annulare. The other nine lesions were of other granulomatous diseases such as foreign-body reaction and late secondary syphilis.