“Drug-resistant granuloma faciale”: treatment with carbon dioxide-GaAs laser

Abstract

Granuloma faciale (GF), also known as "eosinophilic granuloma," is a rare benign leukocytoclastic vasculitis which most commonly occurs on the face of middle-aged Caucasian males. Clinically, GF appears as single or multiple, slowly growing, reddish-brown papules, nodules or plaques which may be cosmetically unpleasant. Its pathogenesis is unknown and GF is notoriously resistant to treatments. Both medical (dapsone, colchicine, gold injections, isoniazid, clofazimine, corticosteroids, psoralen ultraviolet radiation, and topical tacrolimus) and surgical therapies (excision, graft, dermabrasion, argon laser, carbon dioxide laser, pulsed dye laser, cryotherapy, and electrosurgery) have been used for GF but no effective treatment has yet been found. Furthermore, the typical facial location of GF requires an acceptable cosmetic result. We report two cases of drug-resistant GF which were successfully treated with laser vaporization combining two different wavelengths: carbon dioxide (CO ) 10,600 nm and GaAs 1540 nm.

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

“…Based on previous reports, tacrolimus 0.1% ointment applied twice daily seemed to be the most valuable treatment potion for plaque‐type GF with high success rate . However, as delineated by the chronological observation of our case and the published work review, nodular‐type GF, especially those arising around the nose, were resistant to various conservative treatments and sometimes required surgical interventions including laser excision …”

“…It would be noteworthy that four out of 10 perinasal and nodular GF cases achieved complete response lasting up to 18 months after laser removal . However, in these cases, the lesions were localized on the tip or dorsum of the nose and laser irradiation should have been easily performed.…”

“…Granuloma faciale is largely divided into plaque and nodular types . Past reports elucidated that topical application of corticosteroid or tacrolimus have been reported to be effective for the plaque type; however, the nodular type is usually resistant to the therapy and the strategy for managing this subset has not been fully standardized . The published work review found 13 nodular GF cases with detailed clinicopathological information.…”

“…Intriguingly, the lesions were localized around the nose in 10 out of 13 cases, including our case (Table ). Eight out of 10 cases were resistant to initial treatments, such as intralesional corticosteroid, topical corticosteroid, tacrolimus or oral dapsone, and additional interventions were required . Only half of the cases demonstrated complete response .…”

“…The disease‐free period ranged from 8 months to 9 years . Those who achieved complete response were treated with laser therapy (four cases) or by the combination of topical tacrolimus and surgery (one case) …”