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COMMENTARY
Year : 2015  |  Volume : 6  |  Issue : 6  |  Page : 450-451  

Granuloma faciale: A master masquerader?


Department of Dermatology, Government Medical College, Calicut, Kerala, India

Date of Web Publication17-Nov-2015

Correspondence Address:
Najeeba Riyaz
Arakkal, Chalapuram, Calicut, Kerala
India
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Source of Support: None, Conflict of Interest: None


PMID: 26752188

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How to cite this article:
Riyaz N. Granuloma faciale: A master masquerader?. Indian Dermatol Online J 2015;6:450-1

How to cite this URL:
Riyaz N. Granuloma faciale: A master masquerader?. Indian Dermatol Online J [serial online] 2015 [cited 2019 Dec 12];6:450-1. Available from: http://www.idoj.in/text.asp?2015/6/6/450/169716

Granuloma faciale (GF) is a rare disease of unknown etiology, described by John Edwin Mackonochie Wigley (1892-1962) in 1945, as Boeck's sarcoid, and Pinkus, in 1952, suggested the term granuloma faciale.[1] It is characterized by rather asymptomatic facial papules, plaques, and nodules of varying sizes and colors.[2] Rarely, lesions may be painful or itchy. Lesions usually involve sun-exposed areas such as cheeks, nose, forehead, chin, external ear, and preauricular areas. GF lesion mimicking rhinophyma has been reported.[3] Extrafacial lesions may develop occasionally on scalp, trunk, breast, and extremities.[4],[5],[6] Lesions have a smooth surface with follicular accentuation giving a peau de orange appearance and occasional telangiectasia. There are rare reports of keloidal variants of GF occurring on the face and extrafacial sites such as shoulder.[6],[7] A mucosal variant of GF, eosinophilic angiocentric fibrosis (EAF), an unusual fibrotic condition affecting the mucosa of the upper respiratory tract, has been reported recently. This is histologically identical to GF and may be associated with cutaneous lesions of GF.[8] Histologically, GF shows evidence of leukocytoclastic vasculitis with extensive fibrin deposition.[1]

GF is a disease of the middle age and males are frequently affected. Although it is common in whites it has been reported rarely in Japanese and blacks. Sun exposure, polyclonal expansion of CD3+, CD4+, CD8+, and CD30+ T cells with upregulation of cytokines such as IL5[9] and gamma interferon [10] with subsequent inflammatory cell infiltration, have been thought to be etiological factors of GF.

GF is supposed to be a great mimicker clinically. It may resemble several dermatoses such as Sweet syndrome, Kimura's disease, cutaneous T-cell lymphoma, pseudolymphoma, lupus erythematosus, Jessner's lymphocytic infiltration, lymphocytoma cutis, sarcoidosis, and even insect bite reaction.[2]

Skin biopsy is often diagnostic even though there is no granuloma seen histologically (histologic misnomer). A grenz zone, polymorphic infiltrate composed of predominantly eosinophils, neutrophils, histiocytes, plasma cells and lymphocytes, perivascular inflammation with nuclear dust, extravasation of erythrocytes, and extensive deposition of fibrin and hemosiderin suggest that GF could be a subtype of leukocytoclastic vasculitis.[1]

Of late, dermoscopy has been found to be a novel

diagnostic tool for GF. Translucent whitish-grayish structureless areas, intermingled with orthogonal whitish streaks, focused and elongated telangiectasias, or a pink background with whitish areas are the reported dermoscopic findings in GF.[11]

GF is usually resistant to therapy. Various treatment modes have been tried with variable effects such as topical tacrolimus,[12] topical and intralesional corticosteroids, dapsone, antimalarials, isoniazid, clofazimine,[3] and topical nitrogen mustard. A variety of surgical procedures such as surgical excision, dermabrasion, argon laser, pulsed dye laser, carbon dioxide laser, electrosurgery, and cryotherapy have been tried for the management of GF.[13]

 
   References Top

1.
Radin DA, Mehregan DR. Granuloma faciale: Distribution of the lesions and review of the literature. Cutis 2003;72:213-9; quiz 208.  Back to cited text no. 1
    
2.
Ortonne N, Wechsler J, Bagot M, Grosshans E, Cribier B. Granuloma faciale: A clinicopathologic study of 66 patients. J Am Acad Dermatol 2005;53:1002-9.  Back to cited text no. 2
    
3.
Gómez-de la Fuente E, del Rio R, Rodriguez M, Guerra A, Rodriguez-Peralto JL, Iglesias L. Granuloma faciale mimicking rhinophyma: Response to clofazimine. Acta Derm Venereol 2000;80:144.  Back to cited text no. 3
    
4.
Leite I, Moreira A, Guedes R, Furtado A, Ferreira EO, Baptista A. Granuloma faciale of the scalp. Dermatol Online J 2011;17:6.  Back to cited text no. 4
    
5.
Nasiri S, Rahimi H, Farnaghi A, Asadi-Kani Z. Granuloma faciale with disseminated extra facial lesions. Dermatol Online J 2010;16:5.  Back to cited text no. 5
    
6.
Verma R, Das AL, Vaishampayan SS, Vaidya S. Keloidal granuloma faciale with extrafacial lesions. Indian J Dermatol Venereol Leprol 2005;71:345-7.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Singh SK, Rai T, Sharma T. A rare case of keloidal granuloma faciale with extra-facial lesions. Indian Dermatol Online J 2013;4:27-9.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Burns BV, Roberts PF, De Carpentier J, Zarod AP. Eosinophilic angiocentric fibrosis affecting the nasal cavity. A mucosal variant of the skin lesion granuloma faciale. J Laryngol Otol 2001;115:223-6.  Back to cited text no. 8
    
9.
Gauger A, Ronet C, Schnopp C, Abeck D, Hein R, Köhn FM, et al. High local interleukin 5 production in granuloma faciale (eosinophilicum): Role of clonally expanded skin-specific CD4+ cells. Br J Dermatol 2005;153:454-7.  Back to cited text no. 9
    
10.
Smoller BR, Bortz J. Immunophenotypic analysis suggests that granuloma faciale is a gamma-interferon-mediated process. J Cutan Pathol 1993;20:442-6.  Back to cited text no. 10
    
11.
Teixeira DA, Estrozi B, Ianhez M. Granuloma faciale: A rare disease from a dermoscopy perspective. An Bras Dermatol 2013;88(Suppl 1):97-100.  Back to cited text no. 11
    
12.
Gupta L, Naik H, Kumar NM, Kar HK. Granuloma faciale with extrafacial involvement and response to tacrolimus. J Cutan Aesthet Surg 2012;5:150-2.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.
Ludwig E, Allam JP, Bieber T, Novak N. New treatment modalities for granuloma faciale. Br J Dermatol 2003;149:634-7.  Back to cited text no. 13
    




 

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