Granuloma faciale: A clinicopathologic study of 66 patients

Background: Only case reports or studies of small series of patients have focused on granuloma faciale (GF). Objective: We sought to describe the clinicopathologic characteristics of GF in a large series of patients. Methods: We conducted a retrospective analysis of 66 patients and 73 skin specimens. Results: GF mostly presented as reddish plaques or nodules in middle-aged adults. One third of multiple patients had multiple sites involved and 5 patients had extrafacial lesions. A clinical diagnosis of GF was made in only 10 cases; sarcoidosis, lymphoma, lupus, and basal cell carcinoma were the main differential diagnoses. The most frequent histopathologic features were the presence of a grenz zone, neutrophils, and telangiectases. Vascular changes were frequent, although necrotizing vasculitis appeared to be rare. There was often an association of acute chronic inflammatory patterns, suggesting that GF follows a chronic history with recurrent acute phases, rather than distinct successive acute and chronic stages. Limitations: In this retrospective study, a reliable analysis of the outcome of patients could not be performed. Results of direct immunoflourescence tests and laboratory investigations were lacking in many cases. Conclusions: GF is often clinically misdiagnosed; its morphologic spectrum is broader than usually described and includes a lack of eosinophils, the presence of vascular changes with rare vessel wall necrosis, and associated acute and chronic inflammatory patterns.