Chronological observation of surgically‐treated granuloma faciale implies the necessity of circumspect management for perinasal nodular subset

Abstract

Granuloma faciale (GF) is a rare chronic dermatosis with still unknown etiopathology, which usually presents a solitary, asymptomatic, smooth reddish-brown to violaceous plaques or nodules on the face. Various therapeutic approaches, including topical application of corticosteroid or tacrolimus and removal with laser, cryotherapy and surgery have been attempted; however, the outcome has been inconsistent. Herein, we report a case of perinasal nodular GF who repeatedly underwent surgical excisions after the failure of laser treatment. Despite its nomenclature, GF does not manifest granulomatous tissue and the lesion is histopathologically characterized by dense dermal cell infiltration devoid of granulomatous changes and not distinguished by a clear border, which partially explains the difficulty of complete removal in our case. Review of the published work delineated that GF could be largely divided into two clinical subsets: plaque and nodular types. The plaque type GF could be responsive to topical tacrolimus, an approach preferentially adopted nowadays, while nodular type GF was often resistant to topical therapies and required surgical or laser removal. The latter subset often arose around the nose. For this location, surgical excision with sufficient removal margin is sometimes technically difficult when an aesthetically acceptable outcome is expected, explaining the basis for local recurrence. Postoperative recurrence could be observed after years of disease-free period. These observations indicated that the need for respective treatment strategies for the management of distinctive GF subsets. Of note, a multidisciplinary approach combining radical resection and additional supportive intervention with long-term follow up may be required for perinasal and nodular GF.

A case of granuloma faciale successfully treated with systemic dapsone

“…GF lesions frequently present with a smooth surface with superficial telangiectasias and prominent follicular openings with typical “peau d'orange” appearance (Bobyr et al, ) as seen also in our patient. GF consists of two main clinical subtypes, plaque and nodular types (Shimoda‐Komatsu et al, ). Our case can be classified as plaque type GF.…”

“…First‐line treatment of GF includes topical tacrolimus and corticosteroids. Further options are intralesional or systemic corticosteroids, topical and systemic dapsone, hydroxychloroquine, colchicine, cryosurgery, laser therapy, surgical procedures, topical pimecrolimus, clofazimine, and rituximab (Babalola, Zhang, Kristjansson, Whitaker‐Worth, & McCusker, ; Bobyr et al, ; Dourmishev, Ouzounova‐Raykova, Broshtilova, & Miteva, ; Jardim, Uchiyama, Kakizaki, & Valente, ; Lindhaus & Elsner, ; Micallef & Boffa, ; Morgado‐Carrasco, Giavedoni, Mascaro Jr., & Iranzo, ; Ohata & Nakama, ; Santos‐Alarcon et al, ; Shimoda‐Komatsu, Kinoshita‐Ise, Shimoyamada, & Ohyama, ; Wollina, Karte, Geyer, Stuhlert, & Bocker, ; Yuan et al, ). Here, we present the case of a patient who was switched to systemic dapsone after insufficient response to multiple treatments which showed excellent outcome.…”