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C

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E

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G

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H

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I

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J

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N

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O

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P

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R

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S

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T

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U

[Ulcer, oral]
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[Urticaria]

V

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[Vitiligo]

W

[Wart]
[Wiskott-Aldrich Syndrome]

X

[Xanthoma]

Z

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[Zyplast]
 


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Granuloma Faciale

 

What is granuloma faciale?

Granuloma faciale is an order of unknown origin, typically affecting middle-aged white men,  that is characterized clinically by  red-brown or violaceous plaques, almost always on the face. Granuloma faciale is usually without symptoms, though itching or burning may be present. Lesions are usually solitary, ranging in size from millimeters to several centimeters. Multiple lesions are sometimes present. The lesions are soft, well-defined,  with prominent follicles visible.

With what can granuloma faciale be confused?

The clinical appearance of granuloma faciale can sometimes be confused with leprosy, rosacea, lymphoma, pseudolymphoma, sarcoidosis, polymorphous light eruption, lesions of systemic lupus erythematosus, syphilis, mycosis fungoides, and a fixed drug eruption

When granuloma faciale is not on the face, erythema elevatum diutinum (EED) is a key differential diagnosis to consider. EED usually presents as red-brown plaques or nodules on the buttocks, extensor surfaces, and skin overlying joints. The face may be involved as well. The key in distinguishing this entity from granuloma faciale is histology.  EED lacks a Grenz zone, usually manifests epidermal changes, has more neutrophils than eosinophils, and may exhibit prominent lipid-laden macrophages. Vasculitis is also usually more prominent than in granuloma faciale.

How is granuloma faciale diagnosed?

The clinical appearance is suggestive of the diagnosis of granuloma faciale, but a biopsy is required for confirmation.  The specimen shows a diffuse dermal infiltrate of lymphocytes, neutrophils, and, importantly, eosinophils. A Grenz zone (a narrow band of papillary dermis without infiltrate) is present at the dermal-epidermal junction. Leukocytoclastic vasculitis may be present, as well. See Pathology.

 

How is granuloma faciale treated?

The condition is difficult to treat.  Steroids, either topical or intralesional, are often the first attempted treatment. Other pharmaceutical approaches include dapsone and clofazimine. However, granuloma faciale can be difficult to treat. Invasive procedures include: electrosurgery, carbon dioxide laser, cryosurgery, dermabrasion, surgical excision, but scarring often results, and recurrence is possible. Use of a vascular laser (e.g. pulsed dye laser) and PUVA. have been utilized as well.


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What is the prognosis for granuloma faciale?

Granuloma faciale is difficult to treat.  Invasive procedures will often scar, and recurrence is possible.


Image links

DemNetNZ: Fact Sheet and Photos

Other useful links

Wiederkehr, M and Schwartz, RA. Granuloma Faciale. e-medicine. March 22, 2006.


 

Copyright Michael Ehrenreich, MD

www.dermatology.cc | www.goderm.com

 

Date created 07/07/2007

Last updated 10/08/2008