Biopsies of Facial Dermatoses Made Simple

Abstract

Context.-Biopsy of the face is rarely done for inflammatory skin diseases, unless the entire process is confined to the face.Objective.-We hypothesized that facial dermatitis has a differential diagnosis that is more limited than the differential diagnosis of inflammatory skin diseases that affect other parts of the body. To our knowledge, the classification of inflammatory skin diseases occurring on the face has never been conducted before in the English literature.Design.-The most-recent 100 facial biopsies of inflammatory skin conditions were retrieved from our files, and the cases were categorized into the main inflammatory skin patterns.Results.-Forty-seven cases (47%) were categorized as interface dermatitis, 2 cases (2%) as psoriasiform dermatitis, 11 cases (11%) as spongiotic dermatitis, 16 cases (16%) as diffuse and nodular dermatitis, 8 cases (8%) as perivascular dermatitis, 14 cases (14%) as folliculitis and perifolliculitis, 1 case (1%) as panniculitis, and 1 case (1%) as fibrosing dermatitis. The number of diagnostic entities represented within each of these patterns was small.Conclusions.-We believe that facial dermatitis should have its own more-circumscribed differential diagnosis. From a practical viewpoint, many of the inflammatory skin diseases that affect other parts of the body should be excluded from the differential diagnosis after the tissue is determined to be from a facial skin biopsy, and others should not be considered unless the biopsy is from the face.(Arch Pathol Lab Med. 2014;138:550-552; doi: 10.5858/ arpa.2013-0055-OA) P hysicians and scientists interested in the skin have microscopically examined every visible abnormality on our exterior for more than a century, before surgical pathology emerged as a medical specialty and before endoscopic techniques facilitated histopathologic examination of other organ systems. This has resulted in a plethora of clinicopathologic correlation, and the result has been the clinicopathologic definition of literally hundreds of nonneoplastic skin conditions. Therefore, the critical task in assisting pathologists in practicing the dermatopathology of inflammatory skin conditions largely consists of prioritizing that wealth of information, rather than presenting recent discoveries.There is a particular opportunity for the distillation of information when biopsies of facial dermatoses are considered. Most patients affected by an inflammatory dermatosis do not have facial involvement, and sites other than the face are chosen for biopsy. Of those that do occur on the face, most occur synchronously elsewhere on the body. Patients and clinicians prefer that a site other than the face be biopsied whenever possible; therefore, facial biopsies usually come from dermatoses that are confined to the face at the time they present. Therefore, it was our hypothesis that, of the hundreds of inflammatory dermatoses, only a few would regularly appear in facial biopsies, and an analysis of the most recent 100 facial dermatoses submitted to our dermatopathology practi...

Granulomatous Rosacea Histopathologically Confused with Papulonecrotic Tuberculid: A Case Report

“…The differential diagnosis of facial granulomatous lesions can be challenging in some cases [1]. Granulomatous rosacea, demodicidosis, sarcoidosis, granuloma faciale, perioral dermatitis, foreign body reactions, deep fungal infections, Crohn's disease, and Melkersson-Rosenthal syndrome are all characterized by facial granulomas [1,2]. Lupus miliaris disseminatus faciei, tuberculids, and skin tuberculosis are included in the differential diagnosis of facial granulomas that histopathologically show caseification necrosis [1].…”