Granuloma faciale (GF) is an uncommon localized form of a small-vessel vasculitis. It typically affects the face of middle-aged white people, particularly men.
A red-brown plaque or plaques on the face, often with prominent follicular openings, the so called peau d'orange surface. The nose is often involved. Lesions may occur elsewhere. The color is dusky and/or violaceous and the consistency is usually soft. The size may vary from several mm to several cm.
GF may be relatively resistant to treatment. A high potency topical steroid or tacrolimus 0.1% ointment BID (e.g. x 2 months) may be tried initially. However, IL triamcinolone, e.g. 2.5-5.0 mg/cc is usually needed. Dapsone is the treatment of choice for persistent, multiple or extensive lesions. Alternatively, cryotherapy, topical PUVA, dermabrasion, clofazamine or laser may be tried. Specifically, the C02 laser has been used with benefit.
Granuloma faciale was successfully treated with ingenol mebutate [Dermatol Ther. 2016 Jun 30].
CO2 Laser before and 18 months after. [British J Dermatology March 2014]
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