Symmetric bilateral nasolabial granuloma faciale: An unusual rare presentation
Description
Granuloma faciale is a rare benign chronic inflammatory dermatosis, usually appearing as a solitary erythematous to violaceous plaque on the face. Bilateral symmetry involvement has been reported very infrequently and may lead to a diagnostic dilemma owing to a diverse clinical and histopathologic differential diagnosis. We present a case of a 70-year-old hypertensive woman on therapy with valsartan. She developed gradually enlarging, asymptomatic, bilateral lesions affecting both the nasolabial folds. They were well-demarcated, firm, indurated light brown plaques that involved the nasal dorsum and both superolateral nasal walls to the malar area; they had a coarse, gritty texture with numerous tiny papules and micropits, and some darker brown macules were also noticed. Punch biopsy showed focal parakeratosis and a mixed dermal inflammatory infiltrate consisting of lymphocytes, histiocytes, eosinophils, few neutrophils, and foamy macrophages. Dilated superficial dermal vessels with endothelial swelling, erythrocyte extravasation, pigment incontinence, and melanophages were observed, which favor the diagnosis of granuloma faciale. With combined topical treatment of mometasone and tacrolimus for 8 weeks, there was excellent lesion flattening and overall improvement in lesions and cosmetic appearance.