Granuloma Faciale Workup

  • Author: Michael Wiederkehr, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Dec 2, 2011
 

Laboratory Studies

  • No laboratory abnormalities are associated with GF.
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Procedures

  • Obtain an adequate skin biopsy of a representative lesion.
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Histologic Findings

The histologic findings of GF are diagnostic. The name granuloma faciale is a misnomer, as granulomas are never present histologically. The epidermis is unaffected. A grenz zone of uninvolved dermis is located beneath the epidermis. Below the grenz zone is a dense, polymorphous inflammatory infiltrate located most often in the papillary and mid dermis. The infiltrate consists of neutrophils, lymphocytes, eosinophils, monocytes, and, occasionally, mast cells. Vasculitic changes, including perivascular inflammation with nuclear dust and vessel wall damage, are often observed. Extravasated RBCs and hemosiderin deposition are found, which may contribute to the color of the lesions. Later, lesions may show considerable fibrosis around venules. See the images below.

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 aHistologic 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.

Direct immunofluorescence reveals immunoglobulin G, fibrin, and, occasionally, immunoglobulin M deposition at the basement membrane zone and perivascularly.

Electron microscopy reveals more perivascular eosinophils than suggested by light microscopy. Charcot-Leyden crystals, the eosinophil granules, are evident within eosinophils as well as histiocytes, providing evidence of degranulation.

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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, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-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.

Specialty Editor Board

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, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside 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: 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, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M 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, Ackerman Academy of Dermatopathology, New York

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

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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