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Granuloma Faciale Medication

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 10, 2016
 

Medication Summary

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,[22] ), intralesional gold injections, oral bismuth, antimalarials, isoniazid, oral potassium arsenite, p-aminobenzoic acid (PABA), calciferol, topical psoralen UV-A (PUVA),[23] 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.[27]  Dapsone is the oral medication most frequently reported to be of some benefit.[28, 29, 30]  

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Antimicrobial agents

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Dapsone (Avlosulfon)

 

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 (Lamprene)

 

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.

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Calcineurin Inhibitors

Tacrolimus ointment (Prograf)

 

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 (Elidel)

 

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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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Wiederkehr, MD Consulting Staff, Livingston Dermatology Associates; Consulting Staff, Comprehensive Dermatology and Laser Center

Michael Wiederkehr, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Canadian Dermatology Association

Disclosure: Nothing to disclose.

References
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Solitary, well-demarcated, brown-red plaque associated with granuloma faciale.
Solitary, well-demarcated, brown-red plaque associated with granuloma faciale.
Solitary, well-demarcated, brown-red plaque associated with granuloma faciale.
Granuloma faciale.
Histologic findings in granuloma faciale.
Histologic findings in granuloma faciale.
Histologic findings in granuloma faciale.
Histologic findings in granuloma faciale.
Histologic findings in granuloma faciale.
Histologic findings in granuloma faciale include a normal epidermis; a grenz zone of uninvolved dermis just beneath the epidermis; and a dense, polymorphous inflammatory infiltrate located in the papillary and mid dermis. The infiltrate consists of neutrophils, lymphocytes, eosinophils, monocytes, and, occasionally, mast cells. Perivascular inflammation is also observed.
Histologic findings in granuloma faciale.
Multiple brown-red plaques on the face associated with granuloma faciale (same patient as in Media Files 13-16).
Multiple brown-red plaques on the nose associated with granuloma faciale (same patient as in Media Files 12 and 14-16).
Multiple brown-red plaques on the forehead associated with granuloma faciale (same patient as in Media Files 12-13 and 15-16).
Close-up view of multiple brown-red plaques on the forehead associated with granuloma faciale (same patient as in Media Files 12-14 and 16).
Close-up view of multiple brown-red plaques on the nose associated with granuloma faciale (same patient as in Media Files 12-15).
 
 
 
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