Granuloma faciale associated with adenocarcinoma of the prostate

Abstract

A 65‐year‐old man presented to the Dermatology Outpatient Department complaining of an eruption of 10 years’ duration. He also suffered from hypertension, coronary artery disease, and diabetes mellitus for which he received mononitrate isosorbide, propranolol, nifedipine, aspirin, and glimepinide; he showed well‐controlled hypertension and blood glucose. He had consulted several dermatologists since the appearance of the eruption. A diagnosis of cutaneous leishmaniasis had been made. Although the diagnosis had not been confirmed by histology, the patient had received injections of steroids without any apparent improvement. On clinical examination, the eruption was noticed on the front and anterior area of the scalp (Fig. 1). It consisted of pink‐ to red‐colored papules, which had become confluent and formed large plaques. The lesions had extended with time and were totally asymptomatic. Figure 1  Clinical appearance at initial consultation The chronic course of the eruption prompted the performance of a biopsy. Histologic examination of the lesions revealed a slight spongiotic epidermis, below which a zone deprived of cells (Grenz zone) was found. Beneath the Grenz zone, there was a dense, diffusely distributed dermal accumulation of inflammatory infiltrate (Fig. 2), consisting of lymphocytes, eosinophils, histiocytes, and a small amount of nuclear dust. Deposits of eosinophilic material were observed around the walls of some vessels. Direct immunofluorescence revealed fibrinogen and complement C3 on the walls of some vessels. The histologic picture was considered by the pathologist to be compatible with granuloma faciale. 2 Histology of a skin lesion from the anterior area of the scalp. An intense inflammatory infiltrate is evident beneath the Grenz zone Full blood count examination was within normal levels. Blood glucose, urea, creatinine, and liver enzymes were also found to be within normal levels, but serum ferrum was far below the normal value at 11 µg (normal range, 53–167 µg). Ferritin was normal. Although there were no complaints of any associated underlying disease, tumor markers were evaluated. Of the tumor markers, only specific prostatic antigen far exceeded normal levels, with a value of 11.24 ng (normal range, 0–4.0 ng), a result that led to a urology consultation. Prostate examination revealed an edematous, enlarged prostate with a nodule on the left prostate lobe. A biopsy was taken and showed a well‐differentiated prostate adenocarcinoma, Gleason's grade 3. Due to the presence of coronary artery disease, antiandrogen therapy of the prostate adenocarcinoma was first‐choice treatment. Antiandrogen therapy consisted of cyproterone acetate, 300 mg intramuscularly every 2 weeks, and leuproreline acetate, 3.75 mg intramuscularly once a month. With this therapy, within 2 months and parallel to the regression of the tumor, a significant improvement in the skin lesions was noted (Fig. 3). 3 Granuloma faciale in regression under antiandrogen therapy

Assessment of the efficacy of cryosurgery in the treatment of granuloma faciale

“…21 Recently, improvement of GF lesions under treatment with antiandrogen therapy consisting of cyproterone acetate 300 mg intramuscularly every 2 weeks and leuproline acetate 3AE75 mg once a month has been seen in a patient suffering from prostate cancer. 25 Finally, the successful treatment of GF with tacrolimus ointment 0AE1% was recently reported. 19,26 In our study the use of cryosurgery as the sole treatment for GF was proved to be consistently effective without significant side-effects and with no recurrences after a 2-year period of follow-up.…”

“…There is also a single report of successful treatment of GF with topical psoralen and UVA 21 . Recently, improvement of GF lesions under treatment with antiandrogen therapy consisting of cyproterone acetate 300 mg intramuscularly every 2 weeks and leuproline acetate 3·75 mg once a month has been seen in a patient suffering from prostate cancer 25 . Finally, the successful treatment of GF with tacrolimus ointment 0·1% was recently reported 19,26 …”

Granuloma faciale: Is it a new indication for pimecrolimus? A case report

“…However, several infectious agents, immunological disorders and malign diseases are responsible for the pathogenesis (2). Sunlight is considered as a triggering factor because of the location of the lesions and their aggravation by sunlight (4).…”

“…Histopathologically, GF is a localized vasculitis (1). Infections, immunological disorders and malign diseases are responsible for the pathogenesis (2). We report a female patient who was clinically and histopathologically diagnosed with GF and was treated successfully with topical pimecrolimus cream.…”

A new tool to test active ingredient using lactic acid in vitro, a help to understand cellular mechanism involved in stinging test: An example using a bacterial polysaccharide (Fucogel®)

“…This methodology is regularly used in the cosmetic industry. Hence, it is considered as distinguishing sensitive and non‐sensitive skins by many authors and may distinguish biophysical parameters of the skin, including the participation of neurons . However, the mechanism of LA acting as an irritating substance to induce unpleasant sensation is probably linked with a local cutaneous neurogenic inflammation (CNI) on the skin, as recently shown in sensitive skins .…”