Granuloma faciale

Granuloma faciale is a rare, chronic skin condition characterised by single or multiple, smooth plaques or nodules, most often occurring on the face.

This chapter is set out as follows:

• The cause is unknown

• It is seen most commonly in middle-aged white men

Distribution

• Single or multiple lesions
• Although lesions nearly always affect the face, extrafacial involvement can occur

Morphology

• Lesions increase in size gradually to form smooth nodules or plaques, which vary in size from a few mms to several cms
• They are usually red-brown or skin-coloured
• Follicular orifices are usually prominent, as is telangiectatic surface change 

• Histology shows a mixed inflammatory cell infiltrate with a predominance of eosinophils. Vasculitic changes may also be seen 

• Granuloma faciale is a chronic condition with exacerbations and remissions, spontaneous resolution is rare

• Lesions are often recalcitrant to treatment, subsequently many different treatment approaches have been tried including potent and super-potent topical steroids, intralesional steroids, 0.1% tacrolimus ointment, cryotherapy, phototherapy, dapsone and antimalarial therapy. None have been reported as being reliably effective