Granuloma faciale

Published on 19/03/2015 by admin

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Granuloma faciale

Nevianna Tomson and Susan E. Handfield-Jones

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

(© Addenbrooke’s Hospital.)

Granuloma faciale is a rare, benign, chronic inflammatory dermatosis caused by a localized form of cutaneous vasculitis. It presents primarily in middle-aged Caucasian males, usually as a single lesion on the face. Multiple lesions occur in up to a third of patients and there are isolated reports of similar conditions affecting the eye and upper airways.

Lesions are red-brown, violaceous or flesh-colored plaques or nodules with accentuation of follicular openings. Clinical diagnosis is difficult. Differential diagnosis includes sarcoid, lupus, lymphocytoma cutis, persistent insect bite reactions, and lymphoma. The histological differential diagnosis includes erythema elevatum diutinum, and angiolymphoid hyperplasia with eosinophilia.

Management strategy

Granuloma faciale is a chronic condition; spontaneous remission is unusual. Lesions are usually asymptomatic, but treatment is needed to reduce disfigurement. It is notoriously resistant to treatment and, because of the rarity of the condition, there are no formal trials of therapy. Treatment modalities can be divided into destructive techniques and anti-inflammatory approaches. The optimal treatment depends on the size, site, and thickness of the lesions. For isolated or small numbers of lesions intralesional steroid or destructive treatments such as cryotherapy, laser or surgical excision can be used. For multiple or widespread lesions systemic treatment, such as dapsone or clofazimine, can be considered.

Cosmetic camouflage can be helpful for some patients with flatter lesions.

First-line therapies

image Corticosteroids E
image Cryotherapy D
image Laser therapy E
image Surgery E

Second-line therapies

image Dapsone E
image Topical calcineurin inhibitors E

Third-line therapies

image Clofazimine E
image Topical PUVA E

[/level-membership-for-dermatology-category][not-level-membership-for-dermatology-category]

Granuloma faciale

Nevianna Tomson and Susan E. Handfield-Jones

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

(© Addenbrooke’s Hospital.)

Granuloma faciale is a rare, benign, chronic inflammatory dermatosis caused by a localized form of cutaneous vasculitis. It presents primarily in middle-aged Caucasian males, usually as a single lesion on the face. Multiple lesions occur in up to a third of patients and there are isolated reports of similar conditions affecting the eye and upper airways.

Lesions are red-brown, violaceous or flesh-colored plaques or nodules with accentuation of follicular openings. Clinical diagnosis is difficult. Differential diagnosis includes sarcoid, lupus, lymphocytoma cutis, persistent insect bite reactions, and lymphoma. The histological differential diagnosis includes erythema elevatum diutinum, and angiolymphoid hyperplasia with eosinophilia.

Management strategy

Granuloma faciale is a chronic condition; spontaneous remission is unusual. Lesions are usually asymptomatic, but treatment is needed to reduce disfigurement. It is notoriously resistant to treatment and, because of the rarity of the condition, there are no formal trials of therapy. Treatment modalities can be divided into destructive techniques and anti-inflammatory approaches. The optimal treatment depends on the size, site, and thickness of the lesions. For isolated or small numbers of lesions intralesional steroid or destructive treatments such as cryotherapy, laser or surgical excision can be used. For multiple or widespread lesions systemic treatment, such as dapsone or clofazimine, can be considered.

Cosmetic camouflage can be helpful for some patients with flatter lesions.

First-line therapies

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image Corticosteroids E
image Cryotherapy D
image Laser therapy