Background: Granulomatous inflammation is a common histological pattern observed in skin biopsy. Due to the overlapping histological features produced by different etiological agents, granulomatous inflammation poses a diagnostic problem for dermatopathologists. This study aimed to determine the frequency and histomorphological patterns of different granulomatous skin lesions in a tertiary dermatology center. Materials and Methods: This is a retrospective observational study of all skin biopsies with granulomatous skin lesions received in the Department of Dermatopathology, As’ad Al-Hamad Dermatology Center, Kuwait, over five years from 2018 to 2022. Results: Over the last five years, 77 patients were found to have a granulomatous reaction. It was common in females (53.2%), with most occurring in the second to fourth decades. Tuberculoid granulomas were the most frequent (45.5%), followed by xanthogranuloma (19.5%). One-third of the granuloma cases were due to infectious causes. Conclusion: Granulomatous skin diseases are a heterogeneous group of conditions that mainly occur in females and have diverse clinical and histopathological presentations. Tuberculoid granuloma is the leading type in this study. The best method for identifying and classifying granulomatous skin lesions is histopathology in combination with special staining.