Granuloma Faciale Medication
- Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD more...
Granuloma faciale is notoriously resistant to treatment; therefore, many different medical therapies have been tried. Pulsed-dye laser[4, 20, 21] often produces resolution without scarring and should generally be tried before the patient is started on long-term medication. Other therapeutic options that have been tried and are reported to be effective include topical corticosteroid therapy, intralesional corticosteroid injections (without or in combination with 5-fljuorouracil, ), intralesional gold injections, oral bismuth, antimalarials, isoniazid, oral potassium arsenite, p-aminobenzoic acid (PABA), calciferol, topical psoralen UV-A (PUVA), and radiation therapy. More recently, topical tacrolimus has been reported of benefit.[24, 25, 26] Granuloma faciale can also be treated with another topical calcineurin inhibitor, pimecrolimus cream. Dapsone is the oral medication most frequently reported to be of some benefit.[28, 29, 30]
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Dapsone is bactericidal and bacteriostatic against mycobacteria. The mechanism of action is similar to that of sulfonamides where competitive antagonists of PABA prevent formation of folic acid, inhibiting bacterial growth. It has potent anti-inflammatory effects in a variety of skin disorders.
Clofazimine is a lipophilic rhimophenazine dye with antimicrobial and anti-inflammatory properties. The mechanism of action is unclear. It affects neutrophils and monocytes by stimulating phagocytosis and the release of lysosomal enzymes and inhibits neutrophil motility and lymphocyte transformation.
Tacrolimus reduces inflammation by suppressing the release of cytokines from T cells. It also inhibits transcription for genes that encode IL-3, IL-4, IL-5, GM-CSF, and TNF-alpha, all of which are involved in the early stages of T-cell activation. Additionally, it may inhibit the release of preformed mediators from skin mast cells and basophils and down-regulate the expression of FCeRI on Langerhans cells. It can be used in patients as young as 2 years. Drugs of this class are more expensive than topical corticosteroids. It is available as an ointment in concentrations of 0.03 and 0.1%.
Pimecrolimus is a calcineurin inhibitor; it inhibits T-cell activation and hasa also been shown to inhibit the release of inflammatory mediators from mast cells.
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