Skin nontumor
Dermal perivascular and vasculopathic reaction patterns
Granuloma faciale

Editorial Board Member: Robert E. LeBlanc, M.D.
Editor-in-Chief: Debra Zynger, M.D.
Kiran Motaparthi, M.D.

Topic Completed: 29 September 2020

Minor changes: 29 September 2020

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Kiran Motaparthi, M.D.
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Cite this page: Motaparthi K. Granuloma faciale. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/skinnontumorgranulomafaciale.html. Accessed September 29th, 2020.
Definition / general
Essential features
  • Solitary or multiple asymptomatic red-brown plaques on the face
  • Persistent and refractory to treatment
  • Mixed infiltrate with neutrophils, plasma cells and eosinophils
  • Fibrosing vasculitis: leukocytoclasia with perivascular and often storiform fibrosis
ICD coding
  • ICD-10: L92.2 - Granuloma faciale (eosinophilic granuloma of skin)
Epidemiology
Sites
  • Face - forehead, cheeks and nose - most common
  • Extrafacial - trunk or extremities - not uncommon
Pathophysiology
Etiology
  • Unknown at this time
Clinical features
Diagnosis
Prognostic factors
  • Persists indefinitely and frequently refractory to treatment
  • Spontaneous resolution is rare
Case reports
Treatment
  • First line
    • Topical tacrolimus
  • Second line
    • Intralesional corticosteroids
    • Cryotherapy
  • Refractory cases
Clinical images

Images hosted on other servers:
Plaques on the forehead

Plaques on the forehead

Plaque on the nose

Plaque on the nose

Plaques on the forehead and cheek

Plaques on the forehead and cheek

Microscopic (histologic) description
  • Grenz zone
  • Diffuse, polymorphous inflammatory infiltrate involves the upper half of the dermis
    • Neutrophils, plasma cells, eosinophils, lymphocytes and histiocytes
  • Leukocytoclasia (karryorrhexis), extravasated red blood cells and hemosiderin
    • Fibrinoid necrosis of small vessels is variable
  • Perivascular fibrosis with clefting between collagen bundles results in storiform fibrosis
Microscopic (histologic) images

Contributed by Kiran Motaparthi, M.D.
Polymorphous infiltrate with grenz zone

Polymorphous infiltrate with grenz zone

Plasma cells, neutrophils and fibrosis

Plasma cells, neutrophils and fibrosis

Fibrosing vasculitis

Fibrosing vasculitis

Caption

Eosinophils

Virtual slides

Images hosted on other servers:
Granuloma faciale Granuloma faciale

Granuloma faciale

Immunofluorescence description
  • Immunoglobulin and complement deposition within vessel walls and at the dermoepidermal junction are variable (J Cutan Pathol 2006;33:508)
Sample pathology report
  • Skin, nasal dorsum, punch biopsy:
    • Granuloma faciale
Differential diagnosis
Board review style question #1

A 43 year old man presents with an asymptomatic red-brown plaque on the cheek. Which of the following features is characteristic of this disorder?

  1. Cholesterol clefts
  2. Epithelioid endothelial cells
  3. Fibrosis
  4. Germinal centers
  5. Granulomatous inflammation
Board review answer #1
C. Fibrosis. This is granuloma faciale.

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Reference: Granuloma faciale
Board review style question #2
Compared with granuloma faciale, which of the following disorders demonstrates nearly identical histopathologic features?

  1. Angiolymphoid hyperplasia with eosinophilia
  2. Eosinophilic angiocentric fibrosis
  3. Eosinophilic cellulitis
  4. Eosinophilic folliculitis
  5. Eosinophilic fasciitis
Board review answer #2
B. Eosinophilic angiocentric fibrosis

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Reference: Granuloma faciale
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