Granulomatous reaction after cholla cactus spine injury.

Cactus spine injuries are common and can cause long-lasting morbidity in the form of painful granulomatous lesions. Spine removal, corticosteroid ointment, unroofing, and selected excision are possible treatments, though resolution requires several months. We describe the case of a 22-year-old woman with a severe local reaction and pain due to numerous cactus spine granulomas on the left hand. Surgical excision of all lesions using punch biopsies rapidly resolved symptoms without recurrence.