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Granuloma faciale
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Granuloma faciale

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Contributors: Vivian Wong MD, PhD, Belinda Tan MD, PhD, Susan Burgin MD
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Synopsis

Granuloma faciale (GF) is a rare and idiopathic disorder characterized by the formation of asymptomatic red-brown plaque(s), usually on the face. Extrafacial lesions are present in less than 20% of cases. GF occurs most often in middle-aged white men, but it has been described in both sexes and in multiple ethnicities. In the largest series, the mean age was 53 years (range from 20-89 years). Only a handful of cases of GF have been reported in children.

GF is a chronic condition, and the lesions rarely resolve spontaneously. The disease is thought to represent a chronic leukocytoclastic vasculitis.

Codes

ICD10CM:
L92.2 – Granuloma faciale [eosinophilic granuloma of skin]

SNOMEDCT:
61137005 – Granuloma faciale

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Sarcoidosis
  • Granuloma annulare
  • Leprosy
  • Lupus vulgaris
  • Lymphoma – Particularly, B-cell lymphoma may also present as an erythematous to violaceous nodule upon the head and neck of older individuals.
  • Pseudolymphoma / lymphocytoma cutis – A reactive infiltration of inflammatory cells that recapitulate nodal lymphoid tissue; the ear is a particularly common location for lymphocytoma and is an unusual location for GF.
  • Tumid lupus erythematosus – Commonly presents on the sun-exposed face, neck, and upper chest and presents with areas of erythema and induration, but no follicular plugging.
  • Granulomatous rosacea
  • Erythema elevatum diutinum – Extrafacial GF may be very similar, clinically and histologically, to erythema elevatum diutinum (EED), and some authors consider them the same disease in different locations. Histologically, EED typically lacks a Grenz zone and may have prominent lipid-laden macrophages and often a more overt vasculitis.
  • IgG4-related disease – Dermal papules and plaques of the head and neck have been reported.
Pediatric Patient Considerations: In children, where GF is extremely rare, the differential diagnosis includes:
  • Juvenile xanthogranuloma – Presents as an asymptomatic, smooth, round yellow, red, or brown papule(s) upon the head and/or neck.
  • Mastocytoma – Presents as orange to brown papules or patches that blister with manipulation or other events that cause mast cell degranulation.
  • Spitz nevus – Dome-shaped red or pigmented papules or nodules without follicular plugging; Spitz nevi usually present with a period of rapid initial growth and then stabilization in size.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 08/31/2018
Last Updated: 09/06/2018
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Granuloma faciale
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Granuloma faciale : Forehead, Nose, Cheeks
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