Cactus Spine Granuloma

We describe the case of a 45-year-old woman with a 2-week history of painful erythematous papules on the palmar aspect of the fingertips of her right hand, resulting from contact with a cholla cactus 3 weeks prior in Arizona. The patient initially was given clobetasol propionate ointment, resulting in some improvement; however, the lesions resolved only after punch biopsies were performed to confirm the diagnosis of cactus spine granuloma.