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Cutaneous granuloma fissuratum - Skin
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Cutaneous granuloma fissuratum - Skin

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Contributors: Vimal Prajapati MD, Ben Barankin MD, Jeffrey D. Bernhard MD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
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Synopsis

Granuloma fissuratum, also known as acanthoma fissuratum or spectacle frame acanthoma, is a localized skin disorder caused by chronic low-grade trauma due to ill-fitting eyeglass frames. This condition occurs almost exclusively in the upper retroauricular region although the bridge of the nose can also be affected, albeit less commonly. The typical presentation is a solitary, painful skin-colored papule or nodule with a slightly raised edge and characteristic central grooved depression or ulceration. Most cases are unilateral although bilateral cases have been reported in the literature.

Granuloma fissuratum only occurs in individuals who wear eyeglasses. There is no racial or sex predilection and individuals of any age can be affected. Onset is typically gradual, and resolution occurs within 3 weeks to 6 months of adjusting the frames or discontinuing use of the eyeglasses. Continued use of the ill-fitting eyeglasses can result in lesions that have reportedly persisted up to 20 years. Although active treatment is rarely necessary, available options include electrodesiccation and curettage, surgical excision, and intralesional corticosteroid injections.

Codes

ICD10CM:
L25.9 – Unspecified contact dermatitis, unspecified cause

SNOMEDCT:
27745000 – Granuloma fissuratum

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The main differential diagnosis for unilateral cases includes cutaneous malignancies such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and keratoacanthoma.
  • BCCs are more well-circumscribed and pearly with overlying telangiectasia.
  • SCCs are more hyperkeratotic, often with central crusting rather than grooved depression.
  • Keratoacanthoma typically presents as a rapidly growing solitary, hyperkeratotic, skin-colored or erythematous nodule with central keratotic core.

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Therapy

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References

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Last Updated: 09/04/2013
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Cutaneous granuloma fissuratum - Skin
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Cutaneous granuloma fissuratum : Plaque with ulcer, Post auricular scalp, Posterior aspect of ear, Skin erosion, Smooth nodule
Clinical image of Cutaneous granuloma fissuratum
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