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.
Race: primarily seen in Caucasians
Unknown, but may be mediated by immune complex deposition.
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).
Granuloma faciale on the scalp
Cutaneous lupus erythematosus, sarcoidosis, lymphoma, pseudolymphoma, cutaneous T-cell lymphoma, fixed drug eruption, rosacea.
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.
The lesions of GF are usually chronic and only occasionally resolve spontaneously.
Difficult to treat with any modality. Any successful treatment often leaves scarring.
(A) Multiple lesions of granuloma faciale on the face. (B) No significant improvement detected after one treatment with cryotherapy on a 4-month follow-up visit
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).
(A) Indurated brownish-red plaque on the left cheek of a middle-aged female with granuloma faciale. (B) Two-year follow-up showing resolution of granuloma faciale after multiple pulsed dye laser treatments