Dermatopathology
Granuloma faciale: A clinicopathologic study of 66 patients

https://doi.org/10.1016/j.jaad.2005.08.021Get rights and content

Background

Only case reports or studies of small series of patients have focused on granuloma faciale (GF).

Objective

We sought to describe the clinicopathologic characteristics of GF in a large series of patients.

Methods

We conducted a retrospective analysis of 66 patients and 73 skin specimens.

Results

GF mostly presented as reddish plaques or nodules in middle-aged adults. One third of patients had multiple sites involved and 5 patients had extrafacial lesions. A clinical diagnosis of GF was made in only 10 cases; sarcoidosis, lymphoma, lupus, and basal cell carcinoma were the main differential diagnoses. The most frequent histopathologic features were the presence of a grenz zone, neutrophils, and telangiectases. Vascular changes were frequent, although necrotizing vasculitis appeared to be rare. There was often an association of acute and chronic inflammatory patterns, suggesting that GF follows a chronic history with reccurrent acute phases, rather than distinct successive acute and chronic stages.

Limitations

In this retrospective study, a reliable analysis of the outcome of patients could not be performed. Results of direct immunofluorescence tests and laboratory investigations were lacking in many cases.

Conclusion

GF is often clinically misdiagnosed; its morphologic spectrum is broader than usually described and includes a lack of eosinophils, the presence of vascular changes with rare vessel wall necrosis, and associated acute and chronic inflammatory patterns.

Section snippets

Materials and methods

Sixty-six patients with a diagnosis of GF from our institutions were studied retrospectively. We included all archived cases with a diagnosis of GF that fulfilled the following criteria: localized cutaneous disease; facial lesions; absence of systemic symptoms; no history of cutaneous disease or systemic disease; presence of a dermal polymorphous inflammatory infiltrate with uninvolved epidermis and uninvolved cutaneous appendages; presence of eosinophils; and presence of leukocytoclasis.

We

Clinical features

The clinical data are summarized in Table I. Among the 66 patients, there were more men than women–41 and 25, respectively (sex ratio: 1.7). All patients were adults, with ages ranging from 20 to 85 years (mean age: 53 years). Most patients (n = 61, 92%) had facial lesions only (Fig 1). Five patients with extrafacial lesions, four with extrafacial GF only, and one with extrafacial and facial GF were included in the study. These included a 44-year-old woman with a violaceous plaque on her vulva;

Discussion

GF is a rare dermatosis and only isolated case reports and reports of small series of patients have been published to date. In this study, we retrospectively reviewed the clinicopathologic characteristics of 66 patients with GF and 73 skin specimens.

GF may appear in childhood,1 but the youngest patient in this series was 20 years old. Clinically, our middle-aged patients with GF mostly presented with one or more reddish, brown, or violaceous plaques on the face. In accordance with many

References (16)

There are more references available in the full text version of this article.

Cited by (118)

View all citing articles on Scopus

Funding sources: None.

Conflicts of interest: None identified.

View full text
Copyright © 2005 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.