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So you think you know all about Granuloma Faciale?  

Answer these 8 questions.


Dermatopathology Quiz Case 75

Diagnosis: Granuloma Faciale





   A B

A) Erythematous plaque, infiltrated, on the right malar region, with prominent follicular orifices, with a "peau d'orange" aspect

B) Histopathology. Intense mixed inflammatory infiltrate of micronodular aspect, preserving the subepidermal region (Grenz zone)

Courtesy:  Teixeira DA, Estrozi B, Ianhez M. Granuloma faciale: a rare disease from a dermoscopy perspective . Anais Brasileiros de Dermatologia. 2013;88(6 Suppl 1):97-100. doi:10.1590/abd1806-4841.20132384 ( Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License)

Granuloma faciale: a rare disease from a dermoscopy perspective

More images:  Image1  ;  Image2  ;   Image3





1. Who described Granuloma Faciale?            


It was described by Wigley in 1945 as eosinophilic granuloma of the skin, and was further defined by Lever and Leeper Pinkus.


2. How will you define Granuloma Faciale?


Granuloma faciale is a rare, idiopathic dermatosis, of benign course and chronic progression usually noted in middle aged men.


3. What is the clinical presentation of Granuloma Faciale?


The lesion presents as erythematous-brownish papules, nodules or plaques, single or multiple, well-delimited and with a smooth surface. There may be accentuation of follicular orifices and superficial telangiectasias. "Peau d'orange" or pitted appearance has been described. The lesions are often asymptomatic and the patient may experience pruritus or a burning sensation.


4. Which site of the body is commonly affected by Granuloma Faciale?


Typical lesion is a solitary plaque on the face. The lesion is usually noted on the sides of the nose, tip of the nose, preauricular area, cheeks, forehead and helix of the ear.

There are reports of extra facial and disseminated cases.

Extrafacial granuloma faciale has been reported to involve the back, arms, chest, shoulders, and thigh.



5. What are the common predisposing factors of this condition?


Possible predisposing factors include actinic exposure, radiation, trauma, allergy, or an Arthus-like reaction.


6. On microscopic examination, do you see granulomas in Granuloma Faciale ?


No it is a misnomer. Microscopic examination do not show any granulomatous inflammation.


7. What are the top 5 histopathological features of Granuloma Faciale?


(i)   A grenz zone of uninvolved narrow area of the papillary dermis (not all lesions demonstrate this characteristic finding)

(ii)  No pathological changes seen in the epidermis.

(iii) A dense polymorphous, inflammatory cell infiltrate below the Grenz zone consisting of neutrophils, lymphocytes, histiocytes, eosinophils and histiocytes.

(iv) The adnexal structures of the skin are spared.

(v)  Vascular inflammation, including perivascular inflammation with nuclear dust, damage in the vessel wall and presence of eosinophilic fibrinoid material around the vessels.


8. What are the differential diagnosis of Granuloma Faciale?


(i) Eosinophilic Angiocentric Fibrosis -  Although many microscopic features are similar to granuloma faciale, it is located in the sinonasal cavity.

(ii) Erythema Elevatum Diutinum - There is no grenz zone. Eosinophilic fibrinoid material is more prominent and related to blood vessels.The number of neutrophils to eosinophils is higher.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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