Facial granuloma refers to benign inflammatory dermatoses. The etiology of the disease is unknown. In the classic version, these are red-brown or purple nodules or plaques with telangiectasias, which are observed on sun-exposed parts of the body and on the face. The disease is usually asymptomatic and does not cause systemic abnormalities. The patient seeks treatment due to cosmetic problems.
Facial granuloma (Granuloma faciale, GF) is a chronic disease characterized by the development of red-brown plaques on the face.
The skin lesions of facial granuloma show slow growth and tend to be persistent. The disease is known to be resistant to therapy and often tends to relapse after treatment is stopped. A number of therapeutic and surgical methods, such as corticosteroid injections, cryotherapy, dye laser treatment, PUVA therapy, systemic corticosteroids, antimalarials, and dapsone, have been tried with varying success. A carbon dioxide laser is also used for recurrent facial granuloma. Surgical excision is performed with often unsatisfactory results. Ablative procedures can leave pigmentation and scarring, and long-term use of corticosteroids is associated with skin atrophy, telangiectasias, and other possible side effects.
We present the clinical case of a 35-year-old woman with a 5-year history of facial granuloma successfully treated with topical tacrolimus.
Patient, aged 35.
The disease began 5 years ago with one asymptomatic, gray-brown pigmented nodule on the left cheek. At first it was a papule the size of a pinhead, which gradually increased to 2.5 cm x time; 1.5 cm in size. Two years later, similar lesions appeared on the forehead, both arms and upper back. There was no skin ulceration, no photosensitivity, no fever or no joint pain. Personal history without features.
General tests are normal. Skin examinations showed multiple, well-defined, grey-brown, firm plaques ranging in size from 0.5 cm.times. 0.5 cm to 1.5 cm x 2.5 cm present on the left cheek, forehead, both arms and upper back. Distinct follicular openings, telangiectasias, and erythema are visible on the surface of the skin. Macular amyloidosis was present on the upper back
Hematological and biochemical studies were normal. A skin biopsy (4 mm) from the lesion showed normal epidermis and dense infiltrations consisting of neutrophils, lymphocytes, histiocytes, and plasma cells. Small skin vessels showed penetration of neutrophils into the walls and an infiltrate in the subcutaneous adipose tissue. The features are consistent with the diagnosis of "facial granuloma"; (GF).
Treatment. Triamcinolone acetonide 10mg/ml, Dapsone 100mg twice daily was given to the lesion, but without improvement. Then the treatment was stopped and cryotherapy was prescribed. Six sessions of cryotherapy were performed once a month, after which the erythema and itching in the plaque area increased, and the treatment was stopped. Tacrolimus ointment 0.1% twice a day was prescribed. An improvement of 40-50% occurred after 3 months of therapy. The treatment was well tolerated without any side effects.
Discussion
Histological examination for the diagnosis of facial granuloma must be performed to exclude other possible causes of the disease. Differential diagnosis is carried out with lupus erythematosus, lymphoma, deep fungal infection. A skin biopsy is characterized by the presence of an inflammatory infiltrate with a predominance of neutrophils and eosinophils in the dermis, in combination with a slight vascular vasculitis. There is a Grenz zone that separates the infiltrate from the epidermis and hair follicles.
In recent years, successful treatment of facial granuloma using calcineurin inhibitors has been reported. Some authors have reported complete or near complete resolution of skin lesions after topical application of tacrolimus 0.1% ointment. Treatment regimens, duration and time of healing of lesions varied, in some reports the shortest time was indicated - 2 months after using the drug twice a day, in others – in the interval of 4-6 months. In the case presented above, treatment with tacrolimus ointment 0.1% twice daily for 3 months resulted in improvement.
Thus, observations indicate that topical application of tacrolimus ointment is well tolerated and may be effective for the treatment of facial granuloma.
According to Journal of Cutaneous and Aesthetic Surgery
Share:
Add a comment