Granuloma facialeFrom the Ronald O. Perelman Department of Dermatology, New York University
Sherry H Hsiung MD
Dermatology Online Journal 9(4): 39
Granuloma faciale is characterized by indurated, red-brown papules and plaques that usually occur on the face. We present a 52-year-old man with typical clinical and histologic features of this condition. A review of treatment options is presented.
History.—A 52-year-old man complained of a 5-year history of cheek and nose lesions. The patient presented to the dermatology service of the Department of Veterans Affairs New York Harborview Health Care System in May 1998, with a solitary lesion on his left cheek of one year's duration. The patient denied pruritus, tenderness, and discharge. He received intralesional triamcinolone (5 mg/ml) once and topical fluocinonide ointment without benefit. He was not taking any medications. The patient returned on December 2002, for an unrelated complaint. It was noted, however, that the condition persisted and progressed with new lesions on the left cheek and nose.
Physical examination.—A violaceous, indurated plaque was present on the left cheek. Several smaller papules of similar morphology were noted on the right cheek and nose.
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Histopathology.—There is a dense superficial perivascular mixed-inflammatory-cell infiltrate composed of eosinophils, neutrophils, lymphocytes, plasma cells, and macrophages that spares the overlying epidermis and the pilosebaceous units (Grenz zone). The infiltrate is present within the blood vessel walls, which are ectatic and show endothelial swelling. There is also leukocytoclasis.
Granuloma faciale (GF) is a rare cutaneous disorder, which affects middle-aged Caucasian men. The lesions appear as red-brown, well-demarcated plaques, which are most often located on the face, although there have been approximately a dozen case reports of extrafacial lesions .
Histopathologically, early plaques of GF show small vessel vasculitis with relatively scant leukocytoclasia and extravasated erythrocytes . In more mature lesions, a mixed infiltrate of neutrophils, eosinophils, and plasma cells become more prominent with fibrosis. A Grenz zone, which spares the papillary dermis just below the epidermis, is present. Some dermatopathologists have proposed that these features argue that GF and erythema elevatum diutinum are the same disease process occurring at different locations on the body .
There are a variety of treatments for this condition. Destructive modalities have included surgical excision, skin grafts , and liquid nitrogen cryotherapy [5, 6]. Less damaging methods, such as intralesional glucocorticoids, dermabrasion , and dapsone  are nonscarring; however, success is variable. More recently ablation with long-pulsed tunable dye , argon,  and 585-nm pulsed-dye lasers  have been reported with promising results.
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