eMedicine Specialties > Dermatology > Diseases of the Vessels

Granuloma Faciale

Author: Michael Wiederkehr, MD, Consulting Staff, Livingston Dermatology Associates; Consulting Staff, Comprehensive Dermatology and Laser Center
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: May 23, 2008

Introduction

Background

Granuloma faciale (GF) is an uncommon benign chronic skin disease of unknown origin characterized by single or multiple cutaneous nodules, usually occurring over the face. Occasionally, extrafacial involvement is noted,1,2,3,4 most often on sun-exposed areas. Lever and Leeper first recognized GF as a distinct entity in 1950. Pinkus' group suggested the name granuloma faciale that same year. The disease mimics many other dermatoses and can be confused with conditions, such as sarcoidosis, discoid lupus erythematosus, mycosis fungoides, and fixed drug eruption. See Sarcoidosis; Lupus Erythematosus, Discoid; Mycosis Fungoides; and Fixed Drug Eruptions for more information on these topics. 

Pathophysiology

The skin is the primary organ system that is affected. Reports of GF-like lesions of the oral mucosa are rare.5

Frequency

United States

Cases of GF are rare.

Race

GF is found most commonly in whites; however, it has been reported rarely in Japanese and blacks.

Sex

Men are affected more frequently than women.

Age

GF is primarily a disease of middle age (median age, 45 y).

Clinical

History

  • GF is usually asymptomatic.
  • It rarely may be tender or cause itching or stinging.
  • Lesions may darken upon sun exposure.

Physical

  • Solitary or, more commonly, multiple, soft, elevated, and well-circumscribed papules, plaques, or nodules are observed.
  • Lesions are most commonly located over the face. Reported extrafacial locations include the scalp, the trunk, and the upper and lower extremities.
  • The size of the lesions varies from a few millimeters to several centimeters in diameter.
  • The color varies from shades of dull red to brown, blue, and purple.
  • Lesions have a smooth surface with prominent follicular orifices (peau d'orange) and may be covered by telangiectases.

Causes

  • Some cases are idiopathic.
  • Production of interleukin 5 by the clonal T-cell population may cause the attraction of eosinophils to the lesions.6
  • A gamma interferon–mediated process has been suggested.7
  • Sun exposure may play a role.
    • Sunlight-exposed areas are more commonly affected than non–sun-exposed areas.
    • Lesions may darken with sunlight exposure.

More on Granuloma Faciale

Overview: Granuloma Faciale
Differential Diagnoses & Workup: Granuloma Faciale
Treatment & Medication: Granuloma Faciale
Follow-up: Granuloma Faciale
Multimedia: Granuloma Faciale
References
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References

  1. Konohana A. Extrafacial granuloma faciale. J Dermatol. Sep 1994;21(9):680-2. [Medline].

  2. Roustan G, Sánchez Yus E, Salas C, Simón A. Granuloma faciale with extrafacial lesions. Dermatology. 1999;198(1):79-82. [Medline].

  3. Sears JK, Gitter DG, Stone MS. Extrafacial granuloma faciale. Arch Dermatol. May 1991;127(5):742-3. [Medline].

  4. Sewell L, Elston D. Extrafacial granuloma faciale successfully treated with 595-nm pulse dye laser. J Amer Acad Dermatol. Feb 2008;58(2):AB141.

  5. Burns BV, Roberts PF, De Carpentier J, Zarod AP. Eosinophilic angiocentric fibrosis affecting the nasal cavity. A mucosal variant of the skin lesion granuloma faciale. J Laryngol Otol. Mar 2001;115(3):223-6. [Medline].

  6. Gauger A, Ronet C, Schnopp C, Abeck D, Hein R, Köhn FM. High local interleukin 5 production in granuloma faciale (eosinophilicum): role of clonally expanded skin-specific CD4+ cells. Br J Dermatol. Aug 2005;153(2):454-7. [Medline].

  7. Smoller BR, Bortz J. Immunophenotypic analysis suggests that granuloma faciale is a gamma-interferon-mediated process. J Cutan Pathol. Oct 1993;20(5):442-6. [Medline].

  8. Bergfeld WF, Scholes HT, Roenigk HH Jr. Granuloma faciale--treatment by dermabrasion. Report of a case. Cleve Clin Q. Oct 1970;37(4):215-8. [Medline].

  9. Apfelberg DB, Druker D, Maser MR, Lash H, Spence B Jr, Deneau D. Granuloma faciale. Treatment with the argon laser. Arch Dermatol. Jul 1983;119(7):573-6. [Medline].

  10. Wheeland RG, Ashley JR, Smith DA, Ellis DL, Wheeland DN. Carbon dioxide laser treatment of granuloma faciale. J Dermatol Surg Oncol. Sep 1984;10(9):730-3. [Medline].

  11. Dowlati B, Firooz A, Dowlati Y. Granuloma faciale: successful treatment of nine cases with a combination of cryotherapy and intralesional corticosteroid injection. Int J Dermatol. Jul 1997;36(7):548-51. [Medline].

  12. Maillard H, Grognard C, Toledano C, Jan V, Machet L, Vaillant L. [Granuloma faciale: efficacy of cryosurgery in 2 cases]. Ann Dermatol Venereol. Jan 2000;127(1):77-9. [Medline].

  13. Zacarian SA. Cryosurgery effective for granuloma faciale. J Dermatol Surg Oncol. Jan 1985;11(1):11-3. [Medline].

  14. Ammirati CT, Hruza GJ. Treatment of granuloma faciale with the 585-nm pulsed dye laser. Arch Dermatol. Aug 1999;135(8):903-5. [Medline].

  15. Elston DM. Treatment of granuloma faciale with the pulsed dye laser. Cutis. Feb 2000;65(2):97-8. [Medline].

  16. Welsh JH, Schroeder TL, Levy ML. Granuloma faciale in a child successfully treated with the pulsed dye laser. J Am Acad Dermatol. Aug 1999;41(2 Pt 2):351-3. [Medline].

  17. Hudson LD. Granuloma faciale: treatment with topical psoralen and UVA. J Am Acad Dermatol. Apr 1983;8(4):559. [Medline].

  18. Marcoval J, Moreno A, Bordas X, Peyrí J. Granuloma faciale: treatment with topical tacrolimus. J Am Acad Dermatol. Nov 2006;55(5 Suppl):S110-1. [Medline].

  19. Goldner R, Sina B. Granuloma faciale: the role of dapsone and prior irradiation on the cause of the disease. Cutis. May 1984;33(5):478-9, 482. [Medline].

  20. Guill MA, Aton JK. Facial granuloma responsive to dapsone therapy. Arch Dermatol. May 1982;118(5):332-5. [Medline].

  21. van de Kerkhof PC. On the efficacy of dapsone in granuloma faciale. Acta Derm Venereol. Jan 1994;74(1):61-2. [Medline].

  22. Antoniou C, Avgerinou G, Asvesti C. Granuloma faciale. Nouv Dermatol. 1992;11:775-8.

  23. Arbiser JL, Moschella SL. Clofazimine: a review of its medical uses and mechanisms of action. J Am Acad Dermatol. Feb 1995;32(2 Pt 1):241-7. [Medline].

  24. Chatrath V, Rohrer TE. Granuloma faciale successfully treated with long-pulsed tunable dye laser. Dermatol Surg. Jun 2002;28(6):527-9. [Medline].

  25. Dinehart SM, Gross DJ, Davis CM, Herzberg AJ. Granuloma faciale. Comparison of different treatment modalities. Arch Otolaryngol Head Neck Surg. Jul 1990;116(7):849-51. [Medline].

  26. Dinneen AM. Granuloma faciale: Immunohistopathologic study and evidence for eosinophil degranulation. J Invest Dermatol. 1991;96:568.

  27. Gómez-de la Fuente E, del Rio R, Rodriguez M, Guerra A, Rodriguez-Peralto JL, Iglesias L. Granuloma faciale mimicking rhinophyma: response to clofazimine. Acta Derm Venereol. Mar-Apr 2000;80(2):144. [Medline].

  28. Johnson WC, Higdon RS, Helwig EB. Granuloma faciale. AMA Arch Derm. Jan 1959;79(1):42-52. [Medline].

  29. Ortonne N, Wechsler J, Bagot M, Grosshans E, Cribier B. Granuloma faciale: a clinicopathologic study of 66 patients. J Am Acad Dermatol. Dec 2005;53(6):1002-9. [Medline].

  30. Pedace FJ, Perry HO. Granuloma faciale. A clinical and histopathologic review. Arch Dermatol. Oct 1966;94(4):387-95. [Medline].

  31. Phillips DK, Hymes SR. Recurrent facial plaques following full-thickness grafting. Granuloma faciale. Arch Dermatol. Nov 1994;130(11):1433-4, 1436-7. [Medline].

  32. Pinkus H. [Facial granuloma.]. Dermatologica. 1952;105(2):85-99. [Medline].

  33. Rusin LJ, Dubin HV, Taylor WB. Disseminated granuloma faciale. Arch Dermatol. Nov 1976;112(11):1575-7. [Medline].

  34. Vicente Ortega V, Sánchez-Pedreño P, Rodríguez Vicente J. Granuloma faciale: an ultrastructural study. Ultrastruct Pathol. Mar-Apr 1998;22(2):135-40. [Medline].

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Further Reading

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Keywords

GF, granuloma faciale eosinophilicum, granuloma faciale with eosinophilia

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Contributor Information and Disclosures

Author

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 and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Daniel J Hogan, MD, Director of Bay Pines Dermatology Residency Program, Bay Pines Veterans Affairs Healthcare System; 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, and Canadian Dermatology Association
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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