Search

A 28-year-old woman presented with a 2-year history of idiopathic, chronic blepharitis unresponsive to several courses treatment of corticosteroid eye drops. Physical examination was notable for edematous, erythematous plaques of the lower eyelids with madarosis in the absence of preceding skin scarring. Biopsy specimen was obtained and diagnosis of discoid lupus erythematosus (DLE) was made. DLE is a chronic, cutaneous disease that is clinically characterized by a malar rash, acute erythema, and discoid lesions. Localized DLE occurs when the head and neck only are affected, while widespread DLE occurs when other areas are affected, regardless of whether disease of the head and neck is seen. Patients with widespread involvement often have hematologic and serologic abnormalities, are more likely to develop systemic lupus erythematosus, and are more difficult to treat. A number of skin diseases may be confused with DLE, such as psoriasis, seborrheic dermatitis, acne, rosacea, lupus vulgaris, sarcoidosis, Bowen's disease, polymorphous light eruption, lichen planopilaris, dermatomyositis, granuloma annulare, and granuloma faciale. Palpebral lesions may rarely be the presenting or sole manifestation of the disease and lower eyelid involvement is seen in 6% of patients with chronic, cutaneous lupus erythematosus. DLE should therefore be considered as a differential diagnosis in chronic blepharitis or madarosis that persists despite usual medical management and eyelid hygiene. The patient was treated successfully with hydroxychloroquine. The skin lesions resolved with minimal scarring.

Granuloma faciale (GF) is a rare cutaneous disorder categorized as a localized form of small vessel vasculitis. Clinically, it manifests as single or multiple, well-demarcated, red-brown plaques, papules and nodules, nearly always confined to the face. Herein, we report a 39-year-old man with multiple red-brown, infiltrated plaques on his face and extrafacial lesions on the back, shoulders, and both arms. Skin biopsy revealed typical histopathological findings of GF. The patient failed to respond to pulsed dye laser, but intralesional triamcinolone combined with cryotherapy led to an acceptable response.

There is a significant overlap with the nodular and diffuse pattern and the superficial and deep perivascular pattern; indeed, some entities discussed in Chap. 5 could arguably be included in this chapter as well (e.g., arthropod bite reaction). Other entities discussed in this chapter could also conceivably be discussed in the chapter on perivascular dermatitis (e.g., Sweet’s syndrome). The primary difference in the nodular and diffuse patterns from the perivascular pattern is that the inflammation is not just centered on vessels. On scanning magnification, nodular dermatitis is characterized by discrete areas of inflammation, separated by uninvolved areas (Fig. 7.1). In contrast, the diffuse pattern demonstrates dense dermal inflammation without intervening areas of sparing (Fig.7.2). Distinction in individual cases is admittedly arbitrary and subject to individual interpretation. As with automobiles, your mileage may vary.

Eosinophilic angiocentric fibrosis is a rare disease of unknown cause. This disease, which involves the upper respiratory mucosa, resembles another rare entity, granuloma faciale. Allergy is thought to be an etiological factor and complete surgical excision is the preferred treatment. A case of eosinophilic angiocentric fibrosis of the nasal septum causing airway obstruction is presented here. This is the sixth case to be reported in the English literature, with well-documented histopathological confirmation.

Granuloma faciale (GF) is a rare benign chronic inflammatory dermatosis usually appearing only on the face. The lesions of GF typically present as single, asymptomatic, erythematous, non-changing nodules or plaques. We present an illustrative case of GF and briefly review available treatment options.

Granuloma faciale, a rare, chronic, cutaneous disorder, is uncommon in children. Numerous treatment modalities have been used to treat granuloma faciale but none are consistently effective. In addition, many of the previously used therapies have unwanted side effects or are not well tolerated by children. We report a case of granuloma faciale in an 11-year-old child successfully treated with the pulsed dye laser. To our knowledge, this is the first report of this treatment modality for granuloma faciale. (J Am Acad Dermatol 1999;41:351-3.)

Granuloma faciale is an uncommon but well-defined cutaneous condition which is seen almost exclusively on the face [1]. Reports are confined mainly to the dermatology and pathology literature. Between 1966 and 1996 only three articles have appeared in the oral and maxillofacial, otolaryngology or plastic surgery literature [2–4]. A case of granuloma faciale is reported together with a review of the existing literature on this condition.

Granuloma faciale is a rare dermatosis, which is difficult to control therapeutically. A case report of a patient responsive to treatment with dapsone, after failure of other modalities of therapy, is reported. No recurrence after 1 year occurred. The possible action mechanisms and the main side-effects of dapsone are reviewed.

Three patients with a rare extrafacial granuloma eosinophilicum are presented. Lesions were localized on the scalp, the upper back or the upper arm. Only one patient had a typical facial granuloma eosinophilicum at the same time. Diagnosis was established by histopathology. The histopathological findings vary with the age of the lesion. Early lesions are characterized by a vasculitis with many eosinophils separated by a Grenz zone from epidermis and follicular structures. With time the inflammation changes and hyalin fibrosis takes place.

Background:Malasseziapachydermatisispartofthenormal cutaneous microflora of dogs and many other mammals. M pachydermatis has not yet been reported as an agent that causes skin infection in humans, although it has been found to cause fungemia and other nosocomial infections in preterm newborns and immunocompromised adults. Observations: Malassezia pachydermatis was isolated from the facial granuloma of a healthy woman and her dog’sskinscrapingsandcerumen.Theyeastidentitywas established by standard methods and scanning electron microscopy. A skin biopsy specimen showed chronic inflammatory granuloma, numerous purple-red round or ovoidsporesinthesuperficialnecrotictissue,andsparse red spores in the dermis. The skin lesions healed after oral fluconazole and cryotherapy. Conclusions: Definite diagnosis of M pachydermatis– induced skin infection principally depends on the results of fungal culture and histologic examination, and the combination of oral fluconazole and adjunctive cryotherapy seems to be an effective therapeutic regimen.

A 49-year-old male presented at our department with erythematous brownish plaques in the malar areas and left cheek of 9 years' evolution. Histopathological study revealed a dense, predominantly perivascular, inflammatory infiltrate in the reticular dermis. The infiltrate was composed of abundant neutrophils, lymphocytes, histiocytes, and eosinophils. Leukocytoclasia and fibrin in some vessel walls were also observed. The patient was diagnosed with granuloma faciale (GF). Direct immunofluorescence (DIF) study showed heavy immunoglobulin G (IgG) and less intense deposits of IgA, IgM, C(3) and C(1q) surrounding superficial and deep vessels of the reticular dermis. Perivascular and diffuse fibrinogen deposits were also present. No deposits were detected at the dermoepidermal junction. Our findings lend support to the hypothesis that classical pathway activation of complement may be involved in the development of vasculitis in GF.

Granuloma faciale (GF) is a rare cutaneous disorder characterized by one to several soft, erythematous to livid papules, plaques or nodules, usually occurring on the face. Extrafacial lesions are uncommon. A 52-year-old lady with multiple asymptomatic, variously sized brownish-black colored, firm, sharply circumscribed plaques resembling keloids on both cheeks and extrafacial lesions on the right arm and the right breast is presented for its unusual keloidal appearance and typical histopathological findings. She failed to respond to oral dapsone 100 mg daily administered for 3 months. Local infiltration of triamcinolone combined with cryotherapy led to only partial flattening of the lesions. All the skin lesions were excised surgically followed by flap transfer grafting on both cheeks. The cosmetic outcome was highly satisfactory.

Granuloma faciale (GF) is a rare cutaneous condition of unknown origin with characteristic clinicopathological features. It predominantly affects the face and in some causes an unacceptable cosmetic appearance. Numerous medical and surgical treatments have been used with varying degrees of success. Several single-patient case reports have demonstrated the successful use of the pulsed dye laser (PDL) in treating GF. This study assesses the results of four patients with facial GF from one dermatological laser centre that were treated with the Candela Vbeam PDL at 595 nm. Resolution of the GF was achieved in only two of the four patients (50%). Nevertheless this study provides further evidence that the PDL can help some patients with GF. Subsequently it is still a valuable treatment option for GF, especially as it is safe, well tolerated and quick.

Eosinophilic angiocentric fibrosis (EAF) is a rare specific inflammatory condition that affects the nose and upper airways and is characterized by distinctive histopathologic features. We report the clinical, histopathologic, and radiologic features of EAF in an elderly woman who presented to us with complete stenosis of the left nostril, nasal swelling, and granuloma faciale (GF) of the overlying nasal skin. The histopathologic spectrum of the early, intermediate, and late stages of EAF in the deeper nasal tissues is illustrated along with the adjacent changes of GF in the overlying nasal skin. Quantification of immunohistochemically stained lymphocyte cell subsets in the perivascular inflammatory component was performed by using software to compare the proportions of lymphocyte subsets in the two conditions. The results showed similar proportions of perivascular CD4 T lymphocytes in EAF and GF. We believe that both EAF and GF may represent unusual tissue responses. Similar analysis in other cases will help confirm these findings. A review of the literature suggests that the condition, if localized, is amenable to surgical treatment. In progressive late stages, EAF causes fibrotic stenosis of the affected site with localized extension.

A 40-year-old man presented in January 2001 with multiple purple plaques and nodules, which had been present on the back for approximately 3 years. The lesions had gradually extended over the face, trunk and proximal extremities. He had no symptoms except occasional mild pruritus. The patient was in good health and was on no medications. Physical examination revealed multiple violaceous to brown, indurated, 5–50-mm, round to oval plaques on the face, arms, shoulders, and back (Fig. 1), as well as a solitary lesion on the right thigh. Surface telangiectases were noted, especially on the shoulder lesions. There was no scaling or ulceration. Routine laboratory tests were unremarkable. Figure 1. Multiple reddish-brown plaques on the back Download figure to PowerPoint In April 1999, another medical center performed a biopsy of what they thought was sarcoidosis. The results were reported as “possible angiolymphoid hyperplasia with eosinophilia.” With the possibility of granuoma faciale (GF) in mind, another skin biopsy was obtained from a facial lesion. This revealed a diffuse, relatively dense infiltrate of neutrophils, eosinophils and mononuclear inflammatory cells in dermis with an obvious Grenz zone (Fig. 2). Pilar units were intact, and endothelial cell swelling was present (Fig. 3). Retrospective evaluation of the initial biopsy, taken from the back, revealed the same changes, and helped confirm the diagnosis of GF. Figure 2. A diffuse, relatively dense mixed infiltrate, separated from a normal epidermis by a Grenz zone (hematoxylin and eosin, × 40) Download figure to PowerPoint Figure 3. Polymorphous infiltrate containing eosinophils, neutrophils, and lymphocytes surrounding dilated dermal vessels with swollen endothelial cells (hematoxylin and eosin, × 400) Download figure to PowerPoint The patient was treated with liquid nitrogen for 20 s followed immediately by intralesional triamcinolone acetonide (5 mg/ml). This treatment was repeated every 4 weeks for three courses, resulting in partial resolution of the lesions.

A 65-year-old man presented to the Dermatology Outpatient Department complaining of an eruption of 10 years’ duration. He also suffered from hypertension, coronary artery disease, and diabetes mellitus for which he received mononitrate isosorbide, propranolol, nifedipine, aspirin, and glimepinide; he showed well-controlled hypertension and blood glucose. He had consulted several dermatologists since the appearance of the eruption. A diagnosis of cutaneous leishmaniasis had been made. Although the diagnosis had not been confirmed by histology, the patient had received injections of steroids without any apparent improvement. On clinical examination, the eruption was noticed on the front and anterior area of the scalp (Fig. 1). It consisted of pink- to red-colored papules, which had become confluent and formed large plaques. The lesions had extended with time and were totally asymptomatic. Figure Figure 1 . Clinical appearance at initial consultation Download figure to PowerPoint The chronic course of the eruption prompted the performance of a biopsy. Histologic examination of the lesions revealed a slight spongiotic epidermis, below which a zone deprived of cells (Grenz zone) was found. Beneath the Grenz zone, there was a dense, diffusely distributed dermal accumulation of inflammatory infiltrate (Fig. 2), consisting of lymphocytes, eosinophils, histiocytes, and a small amount of nuclear dust. Deposits of eosinophilic material were observed around the walls of some vessels. Direct immunofluorescence revealed fibrinogen and complement C3 on the walls of some vessels. The histologic picture was considered by the pathologist to be compatible with granuloma faciale. Figure 2. Histology of a skin lesion from the anterior area of the scalp. An intense inflammatory infiltrate is evident beneath the Grenz zone Download figure to PowerPoint Full blood count examination was within normal levels. Blood glucose, urea, creatinine, and liver enzymes were also found to be within normal levels, but serum ferrum was far below the normal value at 11 µg (normal range, 53–167 µg). Ferritin was normal. Although there were no complaints of any associated underlying disease, tumor markers were evaluated. Of the tumor markers, only specific prostatic antigen far exceeded normal levels, with a value of 11.24 ng (normal range, 0–4.0 ng), a result that led to a urology consultation. Prostate examination revealed an edematous, enlarged prostate with a nodule on the left prostate lobe. A biopsy was taken and showed a well-differentiated prostate adenocarcinoma, Gleason's grade 3. Due to the presence of coronary artery disease, antiandrogen therapy of the prostate adenocarcinoma was first-choice treatment. Antiandrogen therapy consisted of cyproterone acetate, 300 mg intramuscularly every 2 weeks, and leuproreline acetate, 3.75 mg intramuscularly once a month. With this therapy, within 2 months and parallel to the regression of the tumor, a significant improvement in the skin lesions was noted (Fig. 3). Figure 3. Granuloma faciale in regression under antiandrogen therapy Download figure to PowerPoint

Eosinophilic angiocentric fibrosis (EAF) is an unusual fibrotic condition affecting the mucosa of the upper respiratory tract, of which there have been eight reported cases. The condition is thought to be associated with the rare skin disorder granuloma faciale, which is histologically identical, and was present in two cases of EAF. We report the third case where EAF and granuloma faciale occurred together, to highlight this type of intranasal fibrosis as a distinct pathological entity.

The clinical differential diagnosis of violaceous plaques on the face is broad and includes both neoplasms and inflammatory dermatoses. We report the first case of a basal cell carcinoma (BCC) superficial to an underlying granuloma faciale (GF). This is a single case report with clinicopathological correlation. Histological examination of a skin biopsy from the cheek revealed superficial BCC and GF. This case constitutes the first reported finding of coincident GF and BCC.

plaques, papules or nodules over the dorsa of joints, and GF usually appears as one or a few plaques on the face. In addition, eosinophils and plasma cells are prominent in GF, whereas neutrophils are plentiful in erythema elevatum diutinum [1] . GF is often quite resistant to therapy [2–6] . Topical calcineurin inhibitors may represent a useful alternative to topical corticosteroids for the treatment of a number of other inflammatory skin diseases different from atopic dermatitis [7] . We report a 90-year-old male patient without remarkable medical history who presented to our department with an asymptomatic lesion on the nasal tip. This lesion had been present for 6 months, and gradual enlargement had been observed. Physical examination revealed an oval, well-delimited, reddish yellow plaque, 2.5 ! 1.5 cm in size, with a smooth and brilliant surface. Focal telangiectasia and follicular openings were also found ( fig. 1 ). A biopsy specimen was obtained which showed a dense dermal polymorphous inflammatory infiltrate with neutrophils, lymphocytes, plasma cells and numerous eosinophils. A narrow grenz zone and a mild fibrosis area were also found. With these histological findings, a diagnosis of GF was made. Therapy with topical 0.1% tacrolimus ointment twice daily was started after he had not responded to the application of topical corticosteroids. Treatment was stopped after 3 months with remission lasting for 1 year. Only slight reddish coloration at the edges of the lesion remained ( fig. 2 ). No burning sensation was noted.

A 35-year-old man presented with a 7-year history of gradually enlarging plaques on his face and trunk. The first lesions had developed on both sides of the forehead and the left cheekbone (Figure 1). Four years later similar lesions appeared on his neck and back. He presented a histologic report of a biopsy specimen from a facial plaque performed 5 years earlier that was diagnostic for granuloma faciale. He had different treatments such as topical steroids and cryotherapy without improvement. The appearance of new lesions on his trunk and the gradual enlarging of the old lesions convinced the patient to seek further treatment. Physical examination revealed dusky, violaceous plaques and papules, 0.5 to 2 cm, well-circumscribed, slightly elevated, and located on the face and trunk, with mild pruritus (Figure 1 and Figure 2). Laboratory investigations, including complete blood cell count, VDRL test, antinuclear antibody test, biochemical parameters, and chest x-ray, did not reveal any abnormalities. A skin biopsy taken from the upper part of the back showed similar features to the facial lesion, detected 5 years before, revealing a dense, polymorphous infiltrate involving mid and deep dermis and displaying a diffuse and perivascular pattern (Figure 3A). A narrow grenz zone of normal collagen was consistently observed between dermal infiltrate and epidermis as well as around the pilosebaceous follicles (Figure 3A). The infiltrate mainly consisted of eosinophils and lymphocytes, but neutrophils (often displaying leukocytoclasis), macrophages, and plasma cells were also present (Figures 3B, 3C). Some mast cells were also identified by staining with toluidine blue (Figure 3D). Perivascular infiltrates were often seen, sometimes penetrating vessel walls and in association with leukocytoclasis. Hyalinization of vessel walls, extravasation of red blood cells around capillaries, and nuclear dust were also noted. The epidermis did not show any remarkable change except for slight acanthosis. A diagnosis of granuloma faciale with extrafacial lesions was made, and a systemic therapy with hydroxychloroquine (200 mg twice daily for 6 weeks) was recommended.(1,2).

Background Granuloma faciale is a rare disorder characterized by asymptomatic papules, nodules, and plaques on the face. Although the exact pathogenesis of this disease is unclear, it is considered a variant of leukocytoclastic vasculitis confined to the skin. Several medical and surgical methods have been used to treat it with variable results. Case reports We report nine cases of granuloma faciale treated with a combination of cryotherapy with liquid nitrogen and intralesional injection of corticosteroids. Results The lesions cleared completely in all of the patients without any side-effects. No recurrences have been observed. Conclusions Cryotherapy with liquid nitrogen, followed by intralesional injection of corticosteroids, is a safe and effective method to treat granuloma faciale.

We report a case of granuloma faciale over distal extremities in a 60-year-old man without facial lesions who did not show any response to dapsone.

Granuloma faciale nearly always occurs on the face; extrafacial lesions are extremely rare. This is the tenth reported case. Extrafacial granuloma faciale closely resembles erythema elevatum diutinum; however, they are distinct entities which can be differentiated from each other.

Granuloma faciale (GF) is an uncommon inflammatory dermatosis with characteristic clinical and histologic features. Very little is known about its pathogenesis. We used a battery of immunoperoxidase lymphocyte markers to study the population of hematopoietic cells present in a case of GF. The majority of non-myelocytic hematopoietic cells present were T-helper lymphocytes. The cells stained strongly with antibodies against the interleukin-2 receptor and with anti-lymphocyte functional antigen (LFA 1 alpha) antibodies. Overlying keratinocytes did not stain with ICAM-1 or HLA-DR, which may account for the presence of the Grenz zone in granuloma faciale. These findings suggest that a gamma-interferon-mediated process may play some role in the pathogenesis of this disorder.

Granuloma faciale (GF) is a rare chronic inflammatory skin disease characterized by single or multiple reddish-brown cutaneous plaques or nodules. Although this condition is benign, its clinical course is extremely chronic with poor response to therapy. The typical histopathological features of GF include vasculitis with mixed cellular infiltration; however, its etiopathogenesis remains unknown. Here, we describe the case of a 76-year-old man with GF resistant to topical steroids. Biopsy of the lesion revealed i) dense mixed inflammatory cellular infiltrates of lymphocytes, histiocytes, neutrophils, and eosino­phils, ii) mild perivascular nuclear dust and swollen endothelium of blood vessels, and iii) a narrow Grenz zone beneath the epidermis. Immunohistochemical staining demonstrated mixed cellular infiltrates intermixed with CD1a+ dendritic cells, CD68+ histiocytes, and CD4+ and CD8+ T cells.

• Granuloma faciale is an uncommon cutaneous condition characterized by brownish-red macules, papules, nodules, and plaques. Separate areas of granuloma faciale involving the nasal skin of a 32-year-old man were treated using electrosurgery, carbon dioxide laser, and dermabrasion. All modalities provided good cosmetic and functional outcomes. The relative advantages and disadvantages of each technique are presented. ( Arch Otolaryngol Head Neck Surg . 1990;116:849-851)

A 40-year old woman presented with asymptomatic erythematous well-demarcated, infiltrated plaque of 8 cm x 7 cm in size on the right cheek for past four years. Histopathological study of skin biopsy revealed features of granuloma faciale. Oral dapsone and intralesional corticosteroid caused marked improvement.

REPORT OF A CASE A 42-year-old white man was seen in our dermatology clinic with a 1-year history of a slowly enlarging asymptomatic plaque on the left cheek. He was otherwise healthy and was receiving no long-term medications. On examination, a welldefined firm plaque on the left cheek measured 2.0×2.5 cm in greatest dimensions. It was red-brown in color with a smooth surface texture (Fig 1). A biopsy specimen was taken from the lateral edge of the plaque (Figs 2 through 4). What is your diagnosis? DIAGNOSIS: Granuloma faciale. DISCUSSION Granuloma faciale occurs as soft, elevated, circumscribed plaques or nodules varying in size from a few millimeters to several centimeters. 1,2 The color varies from violaceous to dusky brown. Most patients are asymptomatic, but burning, stinging, tenderness, and itching have been reported. 2 Ulceration never occurs, the surface is smooth, and the follicular orifices are accentuated