GF is a chronic condition, and the lesions rarely resolve spontaneously. The disease is thought to represent a chronic leukocytoclastic vasculitis.
L92.2 – Granuloma faciale [eosinophilic granuloma of skin]
61137005 – Granuloma faciale
Differential Diagnosis & Pitfalls
- Granuloma annulare
- 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.
- 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.