The nosological position of actinic granuloma of O'Brien remains controversial. In this report a typical case is described and the features which distinguish the condition from other closely related granulomatous disorders are discussed. Histological changes are of some value in distinguishing actinic granuloma from atypical facial necrobiosis, granuloma multiforme and granuloma annulare arising in elastotic sites. Final diagnosis, however, is usually based upon the clinical features. Our case showed a successful therapeutic response to intralesional steroid.