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E–CASE REPORT
Year : 2013  |  Volume : 58  |  Issue : 3  |  Page : 245
Granuloma faciale: Exclusively extrafacial


Department of Dermatology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India

Date of Web Publication20-Apr-2013

Correspondence Address:
Trupti V Surana
R. No. 343, P. G. Doctors Hostel, 242, AJC Bose Road, Kolkata 700 020, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.110880

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   Abstract 

We report a case of granuloma faciale over distal extremities in a 60-year-old man without facial lesions who did not show any response to dapsone.


Keywords: Extrafacial, granuloma faciale, grenz zone, polymorphous infiltrate


How to cite this article:
Surana TV, Arghyaprasun G, Saugato B, Falguni N, Gobinda C, Chinmay H. Granuloma faciale: Exclusively extrafacial. Indian J Dermatol 2013;58:245

How to cite this URL:
Surana TV, Arghyaprasun G, Saugato B, Falguni N, Gobinda C, Chinmay H. Granuloma faciale: Exclusively extrafacial. Indian J Dermatol [serial online] 2013 [cited 2019 May 25];58:245. Available from: http://www.e-ijd.org/text.asp?2013/58/3/245/110880

What was known? Granuloma Faciale is a chronic disorder known to occur predominantly over the face.



   Introduction Top


Granuloma faciale (GF) is a rare skin disorder of chronic nature. It is characterized by single or multiple, sometimes erythematous, papules, plaques or nodules, usually involving the face. [1] Involvement of extrafacial sites may rarely be seen, e.g., the trunk, extremities, scalp, but facial lesions are almost always present as well. [2] The lesions may be asymptomatic or be associated with mild pruritus. Extrafacial or disseminated GF has been reported but is very rare. [3],[4],[5],[6] We report a case of an adult with granuloma faciale over distal extremities without facial lesions for its rarity.


   Case Report Top


A 60-year-old man patient presented with multiple persistent asymptomatic erythematous nodules and plaques over dorsum of fingers and toes of both the extremities since last 8 months without any surface changes [Figure 1]. There was no history of pain and redness on cold exposure, arthralgia, or features suggestive of systemic involvement, without any surface changes. The lesions did not show spontaneous regression.
Figure 1: Adult with lesions of GF over distal extremities

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On cutaneous examination, there was no tenderness and the lesions were free from the underlying structures. No other site was involved including the face and mucosa. General and systemic examination was unremarkable. A provisional diagnosis of erythema elevatum diutinum was made. Patient was put on dapsone 100 mg/d but did not show any significant response even after 2 months.

Histopathological examination of one of the lesions revealed hyperkeratosis, hypergranulosis with prominent Grenz zone and a dense polymorphous infiltrate of neutrophils, lymphocytes, plasma cells and very few eosinophils in the dermis [Figure 2]. A diagnosis of GF was thus made.
Figure 2: Photomicrograph of H and E, × 400 showing Grenz zone and dense polymorphous infiltrate in the dermis

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All routine investigations were within normal limits.


   Discussion Top


It was Pinkus who first coined the term GF in 1952. [7] The lesions of GF usually involve the nose, forehead, or cheeks. [7] Extrafacial involvement is rare and has been reported to involve the back, arms, chest, shoulders, and thighs. [3],[4],[5],[6] Our case shows bilateral symmetrical involvement of the acral parts without involving face.

There are both clinical and histological similarities between extrafacial GF and erythema elevatum diutinum (EED), and some authors suggest an association between the two conditions. [8] However, the symmetrical and acral involvement clinically, as well as the absence of Grenz zone with notable fibrosis histologically, helps distinguish EED from GF. In our case, similar presentation like EED was seen, but absence of arthralgia or tenderness of the lesions clinically and presence of Grenz zone and polymorphous infiltrate histologically excluded the possibility of EED.

GF is notoriously resistant to treatment. Many different medical therapies, including topical or intralesional corticosteroids, dapsone, anti-malarials, isoniazid, clofazimine, and topical nitrogen mustard, have been tried with variable results. A variety of surgical procedures, like surgical excision, dermabrasion, argon laser, pulsed dye laser, [9] have been used for the management of GF. Our patient received 2 months of dapsone 100 mg/day with minimal response. He was advised to apply very potent topical corticosteroids and showed substantial response after 1 month.

Thus, the presence of lesions of GF over hands and feet without lesions over face was unique in our case and should be considered in the differential diagnosis of persistent asymptomatic erythematous nodules and plaques over distal extremities.

 
   References Top

1.Pedace FJ, Perry HO. Granuloma faciale. A clinical and histopathologic review. Arch Dermatol 1966;94:387-95.  Back to cited text no. 1
    
2.Stetson CL, Leiferman KM. Eosinophilic dermatoses. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. 2 nd ed. Spain: Elsevier Limited; 2008. p. 369-78.  Back to cited text no. 2
    
3.Rusin LJ, Dubin HV, Taylor WB. Disseminated granuloma faciale. Arch Dermatol 1976;112:1575-7.  Back to cited text no. 3
    
4.Castaño E, Segurado A, Iglesias L, López-Ríos F, Rodríquez-Peralto JJ. Granuloma faciale entirely in an extrafacial location. Br J Dermatol 1997;136:978-9.  Back to cited text no. 4
    
5.Pratap DV, Putta S, Manmohan G, Aruna S, Geethika M. Granuloma faciale with extra-facial involvement. Indian J Dermatol Venereol Leprol 2010;76:424-6.  Back to cited text no. 5
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6.Roustan G, Sánchez Yus E, Salas C, Simón A. Granuloma faciale with extrafacial lesions. Dermatology 1999;198:79-82.  Back to cited text no. 6
    
7.Pinkus H. Granuloma faciale. Dermatol 1952;105:85-99.  Back to cited text no. 7
    
8.Ackerman AB, Mones JM, Petronic-Rosic V. Ackerman's resolving quandaries in Dermatology, Pathology, and Dermatopathology. New York: Ardor Scribendi; 2001.   Back to cited text no. 8
    
9.Welsh JH, Schroeder TL, Levy ML. Granuloma faciale in a child successfully treated with the pulsed dye laser. J Am Acad Dermatol 1999;41:351-3.  Back to cited text no. 9
    

What is new? Granuloma Faciale may very rarely involve extrafacial sites without any facial involvement as in our case


    Figures

  [Figure 1], [Figure 2]



 

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    Abstract
   Introduction
   Case Report
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    References
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