Dermatology Online Journal

Successful treatment of granuloma faciale with tacrolimus
Daniel Mitchell MD
Dermatology Online Journal 10 (2): 23

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I am writing to report a case of granuloma faciale with dramatic improvement on topical tacrolimus alone.

A-59-year-old man was seen in December 2003 for spots on his cheeks of 4-years duration. These plaques had been excised 3 years earlier by a plastic surgeon, but they recurred. He saw another physician and was treated with a variety of salves, none of which helped. He was also treated unsuccessfully with intralesional corticosteroids.

The pt smokes 2 packs of cigarettes per day and drinks 3 cocktails every evening.

Figure 1	Figure 2
Pretreatment

Examination revealed dusky reddish brown plaques on both cheeks (Figs. 1 and 2).

Biopsy revealed superficial vasculitis with marked eosinophilia, consistent with granuloma faciale.

The patient was started on topical tacrolimus ointment (0.1 % applied bid). Now 10 months later, there is almost no discernible disease on either cheek (Figs. 3 and 4).

Figure 3	Figure 4
After 9 months of treatment

Many types of treatment are suggested for granuloma faciale, including excision, topical corticosteroids, intralesional corticosteroids, dapsone, dermabrasion, and laser [1]. I am able to find only one report of treatment of granuloma faciale with topical tacrolimus [2]. This patient failed treatment with excision and with intralesional steroid, but responded well to topical tacrolimus. If others are able to duplicate the degree of success observed in my patient, topical tacrolimus may become the treatment of choice for granuloma faciale.

References

1. Hsiung SH. Granuloma faciale. Dermatol Online J. 2003 Oct;9(4):39. PubMed

2. Ludwig E, Allam JP, Bieber T, Novak N. New treatment modalities for granuloma faciale. Br J Dermatol. 2003 Sep;149(3):634-7. PubMed

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