Granuloma faciale

What is granuloma faciale?

Granuloma faciale is a rare, non-cancerous skin disorder that is characterised by single or multiple papules, plaques or nodules, most often occurring on the face.

Who gets granuloma faciale?

Granuloma faciale most often affects healthy middle-aged white men (average onset of 52 years), although it has been found in males and females of all races and ages.

What are the signs and symptoms of granuloma faciale?

Patients most often present to their doctor after noticing a spot or lesion on their face that then enlarges or multiplies in number over several weeks or months. These lesions are usually:

• Varied in colour: skin coloured, reddish-brown, blue or purple
• Varied in size from a few millimetres to several centimetres
• Elevated and soft
• Characterised by prominent follicles (pores)
• Defined with a border
• On the face, although similar lesions have been found on other parts of the body such as the scalp, trunk and extremities, when they are known as extrafacial granuloma faciale

Granuloma faciale is usually symptomless. Some patients may complain of tender, itching or stinging lesions.

A brown-red plaque on the zygoma - histology confirmed granuloma faciale 

A plaque of granuloma faciale under the lobe of the ear 

Plaques of granuloma faciale on the cheeks 

Red-brown plaques of granuloma faciale on the temple 

A red-brown plaque of granuloma faciale on the temple - scale is unusual 

A shiny red-brown plaque of granuloma faciale on the cheek 

What causes granuloma faciale?

Why granuloma faciale occurs remains unknown but sun exposure has been implicated:

• Lesions appear more often on sun-exposed areas
• Lesions darken when exposed to sun

How is it diagnosed?

Diagnosis is confirmed by skin biopsy and is often necessary to rule out other skin diseases that have similar appearance. Granuloma faciale is characterised by inflammatory cells in the dermis including eosinophils (allergy cells). There is usually a grenz zone of uninvolved upper dermis. Vascular injury due to a leukocytoclastic vasculitis (inflamed blood vessels) is usually evident. Haemosiderin may be present and indicative of extravasation of red cells due to vascular injury, giving the lesions a brown colour.

Differential diagnosis

Skin conditions that may appear similar to granuloma faciale include:

• erythema elevatum diutinum
• sarcoidosis
• cutaneous lupus erythematosus
• polymorphous light eruption
• Jessner lymphocytic infiltration
• lymphocytoma cutis
• mycosis fungoides
• insect bite reaction
• fixed drug eruption
• erythema elevatum diutinum

Treatment of granuloma faciale

Granuloma faciale is a chronic condition with exacerbations and remissions. Spontaneous resolution rarely occurs. The disease appears not to have any relationship to internal disease and treatment is mainly to improve the appearance. Various medical and surgical therapies have been used but none have been consistently successful. Granuloma faciale also has the tendency to recur after treatment.

Medical therapies used with varying results include:

• Topical steroids
• Corticosteroid injections
• Topical calcineurin inhibitor
• Dapsone (oral and topical)
• Antimalarial tablets (hydroxychloroquine)
• Dapsone
• Clofazamine
• Intralesional rituximab
• Topical psoralen UV-A (PUVA)
• Radiation therapy

Surgical therapy may also be used. Results are variable and may leave scarring.

• Surgical excision
• Dermabrasion
• Electrosurgery
• Cryotherapy
• Lasers (eg, CO2, KTP, pulsed dye, argon)

What is the outcome for granuloma faciale?

Spontaneous resolution is uncommon and therapy is usually requested by sufferers.