Chapter 31: Granuloma Faciale

INTRODUCTION

Granuloma faciale (GF) was first described by Wigley in 1945 who labeled the disease “eosinophilic granuloma.” Pinkus renamed this disorder granuloma faciale in 1952. GF is an idiopathic chronic cutaneous disorder that usually involves the face, particularly the nose. It can present with a single lesion or multiple lesions.

EPIDEMIOLOGY

Incidence: uncommon

Age: 30 to 50 years

Race: primarily seen in Caucasians

Sex: males > females

PATHOGENESIS

Unknown, but may be mediated by immune complex deposition.

PHYSICAL EXAMINATION

Single indurated facial brownish-red papule or plaque. Some lesions may have telangiectasia. Multiple lesions may be present. Extrafacial sites rarely observed. Lesions may vary in size from millimeters to centimeters (Fig. 31.1).

DIFFERENTIAL DIAGNOSES

Cutaneous lupus erythematosus, sarcoidosis, lymphoma, pseudolymphoma, cutaneous T-cell lymphoma, fixed drug eruption, rosacea.

DERMATOPATHOLOGY

Dense, polymorphous inflammatory cell infiltrate in the upper two-thirds of the dermis. The infiltrate is composed of numerous eosinophils, neutrophils, lymphocytes, and histiocytes. A prominent grenz zone is characteristically present. Leukocytoclastic vasculitis is frequently observed.

COURSE

The lesions of GF are usually chronic and only occasionally resolve spontaneously.

MANAGEMENT

Difficult to treat with any modality. Any successful treatment often leaves scarring.

Topical Treatment

• Corticosteroids: topical, intralesional

• Tacrolimus ointment (0.1%)

Systemic Treatment

• Dapsone

• Antimalarials

• Colchicine

• Clofazimine

• Gold injections

SURGICAL TREATMENT

• Cryosurgery: multiple reports indicating successful clearance. Results are unpredictable (Fig. 31.2).

• Surgical excision.

• Dermabrasion.

• Electrosurgery.

Light Treatment

• Topical psoralen and ultraviolet A (PUVA) radiation therapy

• Laser therapy: different lasers have been used in the treatment of GF with promising results, either as an ablative therapy with carbon dioxide laser or as a selective therapy targeting the prominent vasculature in GF lesions using the Q-switched argon laser, pulsed dye, diode laser, and potassium titanyl phosphate (KTP) 532-nm laser (Fig. 31.3).