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Skin-nontumor

Other dermatoses

Granuloma faciale


Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns (Canada) (see Reviewers page)
Revised: 31 July 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Mainly middle aged and older; also reported in children
● Facial lesions resemble infected nevus, sarcoidosis and tumor
● Also occurs on trunk

Treatment
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● Recurs after surgical excision, even after full thickness grafts

Case reports
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59 year old man successfully treated with tacrolimus; 52 year old man with classic features

Clinical description
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● Thickened purple patches, plaques or nodules

Micro description
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● Dense cellular infiltrate, often with a nodular outline, occupies the mid dermis
● Deep dermis and subcutaneous fat may be involved
● Typically spares the immediate subepidermis and hair follicles, forming a Grenz zone
● Infiltrate is polymorphic, containing eosinophils, neutrophils and an admixture of plasma cells, mast cells and lymphocytes
● Red cell extravasation is often present
● Blood vessels appear dilated and their walls are infiltrated by eosinophils and fibrin deposition
● Older lesions may show fibrosis and hemosiderin deposition
● In late stage, histology resembles erythema elevatum diutinum

Positive stains
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● Granular IgG at dermal-epidermal junction; also outlines the hair follicles and walls of blood vessels
● Less often IgA and IgM are present

Differential diagnosis
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Mycosis fungoides: has Pautrier microabscesses and atypical cells
Arthropod bites: rare on face
Localized chronic fibrosing vasculitis: similar but not classic microscopic findings
Erythema elevatum diutinum
Neutrophilc dermatosis
Langerhans cell proliferative disorder
Angiolymphoid hyperplasia with eosinophilia

Additional references
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eMedicine

End of Skin-nontumor > Other dermatoses > Granuloma faciale


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