Solitary Langerhans cell histiocytosis orbital lesion: case report and review of the literature. Granuloma eosinófilo de la orbita: caso clínico y. The granuloma faciale is a rare and benign skin disease of unknown etiology, characterized by chronic leukocitoclastic vasculitis. It is characterized by skin. Índice Editorial Complexo granuloma eosinofílico em felinos: revisão de literatura Jane Guimarães Sandoval, Anamaria Esmeraldino, Norma Centeno.

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The granuloma faciale is a rare and benign skin disease of unknown etiology, characterized by chronic leukocitoclastic vasculitis.

Eosinophilic granuloma

It is characterized by skin lesions predominantly facial whose granupoma is chronic and slowly progressive. The diagnosis is based on clinical features, histopathology and, more recently, in dermoscopy. We describe the case of a male patient, 40 years old, with a sarcoid lesion on the malar site, whose histopathological examination revealed a mixed inflammatory infiltrate with presence of Grenz zone.

Dermoscopy revealed a pink background with white striations. The definitive diagnosis is made by histopathologic evaluation, and dermatoscopy can be helpful.

It is known to be resistant to therapy, oral medications, intralesional and surgical procedures are options. Dermoscopy; Diagnosis; Diagnosis, differential; Eosinophilic granuloma; Facial dermatoses; Pathology. A dermatoscopia revelou um fundo rosado com estrias brancas. Granuloma faciale GF is a rare and benign skin disease characterized by chronic leukocytoclastic vasculitis with dense infiltration of polimorfonucleares.

Diagnosis is based on clinical features, histopathology and, more recently, dermatoscopy. The following report shows the importance of including GF in the differential diagnosis of face sarcoid lesions and analyses its dermoscopic features. Male patient, 40 years old, referred an erythematous-edematous asymptomatic lesion in the right malar region for 4 eosinofiluco.

He denied other skin lesions, systemic symptoms and comorbidities. He was using topical steroids betamethasone dipropionate 0. Physical examination showed erythematous plaque, infiltrated, on the right malar region, with prominent follicular orifices, assuming a ” peau d’orange” appearance. Erythematous plaque, infiltrated, on the right malar region, with prominent follicular wosinofilico, with a “peau d’orange” aspect.


The dermoscopic examination showed a pink background, with fosinofilico areas blackened, white striations in different directions and prominent follicular orifices Dosinofilico 2. Pink background with some areas blackened, white striations in different directions and prominent follicular orifices.

Histopathological examination showed intense mixed inflammatory infiltrate of micronodular aspect, composed of lymphocytes, histiocytes, neutrophils and numerous eosinophils. The described infiltration had not reached eosinofilcio subepidermal region Grenz zone and there was no evidence of vasculitis Figure 3. Intense mixed inflammatory infiltrate of micronodular aspect, preserving the subepidermal region Grenz zone.

GF was diagnosed based on clinical examination, dermoscopy and histopathological aspects. Intralesional corticosteroid and prednisone were suspended. The patient returned after nine months of treatment with partial improvement Figure 4. Partial improvement on clinical aspect after nine months of treatment. The term GF was originally described by Wigley in as eosinophilic granuloma of the skin, and was further defined by Lever and Leeper Pinkus a few years later.

Granuloma faciale has an unknown etiology, but possible predisposing factors include actinic exposure, granuloa, trauma, eosinofilicp, or an Arthus-like reaction.

Clinically, GF manifests as papules, plaques or nodules, solitary or multiple, with tranuloma tendency to ulceration, whose color varies from red to violet. The typical lesion is a solitary plaque on the face, as presented by our patient. Extrafacial involvement is rare and has been reported to involve the back, arms, chest, shoulders, and thigh.

The only extracutaneous lesion, whose association was described with graniloma granuloma, is eosinophilic angiocentric fibrosis, which affects the mouth and upper airways. The main clinical differential diagnoses include erythema elevatum diutinum, sarcoidosis, cutaneous lymphomas, lymphocytoma cutis, discoid lupus, basal cell carcinoma, lymphocytic infiltrate of Jessner, fixed drug eruption, lupus vulgaris, fungal eosinofiilco mycobacterial infections.

The only report of GF dermoscopy revealed translucent whitish-grayish structureless areas, eoainofilico with orthogonal whitish streaks and the presence of focused and elongated telangiectasias, similar to streaks identified in dermoscopy of the described case; the pink background, with follicular accentuation of the case, does match with the clinical appearance of ” peau d’orange “.

Clinically, GF may mimic cutaneous sarcoidosis, discoid lupus erythematosus and lupus vulgaris. Histopathologically, GF is characterized by the presence of an unaltered epidermis, which is separated from a zone of dermal inflammation by a grenz zone of uninvolved upper dermis.


Erythrocyte extravasation and granuloam deposition were found, which may have contributed to the color of the lesion. The laboratory evaluation was normal except for occasional mild blood eosinophilia. The disease is known to be notoriously resistant to therapy, although in some cases it can resolve spontaneously.

The use of topical tacrolimus has recently been demonstrated as a safe and effective option. This immunomodulatory agent inactivates calcineurin leading to blockage of T cell activation and inhibition of interferon secretion. Among the treatments available, we chose dapsone and intralesional corticosteroids. Therapeutic response was partial improvement, consistent with the data found in the literature.

This case demonstrates the importance of including GF between the clinical differential diagnosis of sarcoid lesions of the face and describes the usefulness of dermoscopy as a further tool for identification and differentiation. J Am Acad Dermatol. New treatment modalities for granuloma faciale.

Granuloma faciale: a rare disease from a dermoscopy perspective

Granuloma faciale with disseminated extra facial lesions. Dermoscopy of cutaneous sarcoidosis. Dermoscopy in active discoid lupus. Dermoscopy of small basal cell carcinoma: This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Services on Demand Journal. In addition, some milia like cysts and whitish reticular streaks are observed. December 20, ; Accepted: Rio Branco, granulom How to cite this article.

Translucent yellow to orange globular-like or structureless areas associated with linear vessels. Fine focused telangiectasias on a typical yellow to gold-colored background. In addition, some milia. Erythema, keratin plugs and pigmentary changes are variably present.