Granuloma Faciale

    Article Contributors: 
    Neal Kumar

     

    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.

    Copyright : Mitsuhiro Sugiura, M.D.

    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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