Granuloma Faciale

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Clinical features

Solitary or, more commonly, multiple, soft, elevated, and well-circumscribed papules, plaques, or nodules are observed.
Lesions are most commonly located over the face. Reported extrafacial locations include the scalp, the trunk, and the upper and lower extremities.
The size of the lesions varies from a few millimeters to several centimeters in diameter.
The color varies from shades of dull red to brown, blue, and purple.
Lesions have a smooth surface with prominent follicular orifices (peau d'orange) and may be covered by telangiectases.

Histological features

The epidermis is unaffected.
A grenz zone of uninvolved dermis is located beneath the epidermis. Below the grenz zone is a dense, polymorphous inflammatory infiltrate located most often in the papillary and mid dermis.
The infiltrate consists of neutrophils, lymphocytes, eosinophils, monocytes, and, occasionally, mast cells.
Vasculitic changes, including perivascular inflammation with nuclear dust and vessel wall damage, are often observed.
Extravasated RBCs and hemosiderin deposition are found, which may contribute to the color of the lesions.
Later, lesions may show considerable fibrosis around venules.
Direct immunofluorescence reveals immunoglobulin G, fibrin, and, occasionally, immunoglobulin M deposition at the basement membrane zone and perivascularly.
Electron microscopy reveals more perivascular eosinophils than suggested by light microscopy. Charcot-Leyden crystals, the eosinophil granules, are evident within eosinophils as well as histiocytes, providing evidence of degranulation.

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