Extrafacial granuloma faciale: report of a case and response to treatment

Granuloma faciale (GF) is a rather uncommon form of chronic vasculitis that infrequently involves extrafacial sites. Treatment of this disease is extremely challenging. We report a case of GF with extrafacial lesions and a unique response to treatment. The diseases that are clinical and histologic mimics of this disorder, as well as a review of various treatment modalities, are discussed.     

Direct immunofluorescence in granuloma faciale: a case report and review of literature

A 49-year-old male presented at our department with erythematous brownish plaques in the malar areas and left cheek of 9 years' evolution. Histopathological study revealed a dense, predominantly perivascular, inflammatory infiltrate in the reticular dermis. The infiltrate was composed of abundant neutrophils, lymphocytes, histiocytes, and eosinophils. Leukocytoclasia and fibrin in some vessel walls were also observed. The patient was diagnosed with granuloma faciale (GF). Direct immunofluorescence (DIF) study showed heavy immunoglobulin G (IgG) and less intense deposits of IgA, IgM, C(3) and C(1q) surrounding superficial and deep vessels of the reticular dermis. Perivascular and diffuse fibrinogen deposits were also present. No deposits were detected at the dermoepidermal junction. Our findings lend support to the hypothesis that classical pathway activation of complement may be involved in the development of vasculitis in GF.     

面部肉芽肿一例

患者,男,63岁。鼻右侧暗红色浸润性斑块2年,约2cm×4cm,界限清楚,无萎缩、破溃及鳞屑,质地较韧,无压痛。组织病理:表皮大致正常,真皮、皮下组织见大量结节样混合炎细胞浸润,多分布在皮肤附属器及血管周围,与表皮间可见狭窄的无浸润带,血管内皮细胞肿胀、轻度增生。诊断为面部肉芽肿。     

Immunofluorescence findings in granuloma faciale: report of two cases

BACKGROUND: Immunofluorescence findings in granuloma faciale have been infrequently described. Reported findings include granular IgA, IgG, IgM, and C3 deposits in the dermoepidermal junction, in blood vessel walls, and on connective tissue fibers; IgG in the basement membrane zone, and IgG around blood vessels. OBSERVATIONS: We report two cases of granuloma faciale in which biopsy specimens were sent for routine pathology as well as immunofluorescence. Additional work-up included serologic testing for markers of lupus erythematosus (LE). Immunofluorescence in both cases revealed granular IgA, IgG, IgM, C3, and C5-9 deposits along the dermoepidermal junction only. Blood vessel walls and connective tissue fibers were spared. Serologic studies for markers of LE were negative. CONCLUSION: Immunofluorescence findings were essentially identical to those which would be expected in cutaneous LE; however, the combination of negative serologic studies for LE, histopathologic findings typical of granuloma faciale, and clinical findings most consistent with granuloma faciale allowed the diagnosis of granuloma faciale to be rendered with certainty. Interpretation of results of direct immunofluorescence of skin should be correlated with clinical presentation, histopathological findings and other laboratory results in order to render final diagnosis of a given patient.     

Disseminated granuloma faciale

A 40-year-old man presented in January 2001 with multiple purple plaques and nodules, which had been present on the back for approximately 3 years. The lesions had gradually extended over the face, trunk and proximal extremities. He had no symptoms except occasional mild pruritus. The patient was in good health and was on no medications. Physical examination revealed multiple violaceous to brown, indurated, 5-50-mm, round to oval plaques on the face, arms, shoulders, and back (Fig. 1), as well as a solitary lesion on the right thigh. Surface telangiectases were noted, especially on the shoulder lesions. There was no scaling or ulceration. Routine laboratory tests were unremarkable. In April 1999, another medical center performed a biopsy of what they thought was sarcoidosis. The results were reported as "possible angiolymphoid hyperplasia with eosinophilia." With the possibility of granuoma faciale (GF) in mind, another skin biopsy was obtained from a facial lesion. This revealed a diffuse, relatively dense infiltrate of neutrophils, eosinophils and mononuclear inflammatory cells in dermis with an obvious Grenz zone (Fig. 2). Pilar units were intact, and endothelial cell swelling was present (Fig. 3). Retrospective evaluation of the initial biopsy, taken from the back, revealed the same changes, and helped confirm the diagnosis of GF. The patient was treated with liquid nitrogen for 20 s followed immediately by intralesional triamcinolone acetonide (5 mg/ml). This treatment was repeated every 4 weeks for three courses, resulting in partial resolution of the lesions.     

Majocchi's肉芽肿一例

患者,女,68岁。右侧腕部红斑、丘疹、结节伴疼痛1年半,加重2个月。组织病理学示肉芽肿性改变,HE荧光染色及真菌培养显示红色毛癣菌。诊断:Majocchi's肉芽肿。患者给予抗真菌治疗,皮疹痊愈,随访一年无复发。     

Dermoscopy of granuloma faciale: a description of a new finding

Granuloma faciale is a rare, chronic dermatologic disorder, which mainly affects the face. Recently, dermoscopy has been demonstrated as an important ancillary tool on the clinical diagnosis of facial dermatoses. We report two cases of granuloma faciale with yellow areas on dermoscopy that was not yet described in the literature, corresponding to abundant hemosiderin on histopathological examination.     

Cutaneous mercury granuloma: a case report

Cutaneous mercury (Hg) granuloma is a rare disorder caused by the traumatic introduction of elemental Hg into skin or soft tissue. Typically, cutaneous elemental Hg deposits cause limited systemic effects. Prominent systemic toxicity may, however, occasionally occur. Herein we report a case of cutaneous Hg granuloma resulting in chronic painful local wounds and systemic toxicity in the form of abdominal pain, visual disturbances, and psychiatric abnormalities. The related literature also is reviewed.     

静脉内化脓性肉芽肿

报告1例静脉内化脓性肉芽肿.患者男,75岁.因左手拇指结节3年就诊.组织病理学检查示真皮内一扩张静脉,内有大量毛细血管增生.增生的血管被纤维组织分隔形成典型分叶状结构.诊断为静脉内化脓性肉芽肿.     

局限型环状肉芽肿一例

<正>临床资料患者,男,63岁。额头结节6个月。患者6个月前无明显诱因于额头部出现淡红色的丘疹,患者未重视,皮疹逐渐增大为结节,无水疱、破溃,自觉轻度瘙痒,无疼痛,未于院外诊治。患者既往体健,无高血压、冠心病、肝炎、结核等病史,无手术、药物过敏史,家族史中无类似疾病史。体格检查:一般     

鱼刺伤肉芽肿一例

患者,女,43岁。右手背、右前臂红斑、触痛性结节2个月。发病前患者右手中指远节伸侧被海虾钳刺伤。组织病理不排除感染性肉芽肿。给予利福平、克拉霉素,病情好转。综上诊断为鱼刺伤性肉芽肿。     

泛发性环状肉芽肿 1例

患者男性，72岁，躯干，四肢出现逐渐增多的圆形或椭圆形红色丘疹，表面光滑无鳞屑，部分融合成片。组织病理变化符合环状肉芽肿。     

间质性蕈样肉芽肿一例

患者女,36岁,因躯干、四肢红斑、鳞屑伴瘙痒3年就诊。皮肤科检查：患者胸腹部、臀部可见边界不清的淡红斑,其上覆层状白色鳞屑。皮损组织病理学检查：真皮浅层单一核细胞灶状浸润,部分细胞有亲表皮性,亲表皮细胞有轻度异形,真皮中层胶原纤维束间可见单一核细胞呈间质性浸润和少许黏蛋白沉积。真皮浅中层散在浸润的单一核细胞均阳性表达T辅助细胞免疫表型。诊断：间质性蕈样肉芽肿。     

Granuloma faciale successfully treated with topical tacrolimus: a case report

Granuloma eosinophilicum faciale (GF) is a rare chronic inflammatory disorder of unknown etiology. Although the condition is benign, its treatment is often unsatisfactory. We describe a case of a 60-year-old man with GF resistant to therapy with topical corticosteroids and liquid nitrogen. After 4 months of treatment with topical tacrolimus the lesions resolved, with remission lasting for 2 years.