Facial granuloma: causes, symptoms, diagnosis, treatment

Facial granuloma (syn.: eosinophilic facial granuloma) is a rare disease of unclear etiology. Trauma, immune and allergic reactions, and increased sensitivity to light are assumed to play a role in the development of facial granuloma. The clinical picture is characterized by one or several sharply defined stagnant-cyanotic spots with a brownish tint and a smooth surface, often with expanded funnels of hair follicles, small telangiectasias. The most common localization is the nose, cheeks, forehead, and they are very rarely located in other places. In addition to spots, nodular-plaque and nodular elements can sometimes be observed.

Pathomorphology of facial granuloma. In fresh elements in the upper part of the dermis, a polymorphic cellular infiltrate is revealed, separated from the epidermis by a strip of unchanged collagen. The infiltrate consists mainly of neutrophilic and eosinophilic granulocytes, among which there are lymphocytes, histiocytes, plasma cells and tissue basophils in varying quantities. There are erythrocyte extravasates, which result in hemosiderin deposits, which in some cases cause a brownish coloration of the foci. The number of eosinophils varies, in some cases they occupy a large part of the infiltrate, in others - there are few of them. Changes in the vessels are always found, sometimes of the type of fibrinoid necrosis, around which clusters of neutrophilic granulocytes with phenomena of disintegration and the formation of "nuclear abscess" are noted. In old foci, infiltration is less pronounced, fibrosis of the dermis with proliferation of fibroblasts is observed. Changes in the vessels are characterized by fibrosis, sometimes with hyaline deposition. Such a histological picture gives grounds to classify this disease as vasculitis.

Histogenesis. Immunofluorescence data from skin lesions also indicate vascular damage. AL Schroeter et al. (1971) found deposits of IgG, IgM, IgA, fibrin, and complement in the dermoepidermal basement membrane zone and around vessels with direct immunofluorescence. S. Wieboier and GL Kalsbeek (1978) found granular deposits of IgG and C3 complement component along the dermoepidermal zone near vessels, where they also found other complement immunoreactants and fibrin.

Electron microscopy revealed a great many eosinophils and histiocytes in the infiltrate, and in their cytoplasm - Charcot-Leyden crystals, which are an ultrastructural marker of facial granuloma. Clusters of eosinophils with decay phenomena near the vessels secrete enzymes that damage the vessels and a chemotactic factor for histiocytes. Histiocytes in facial granuloma do not contain Langerhans granules, unlike those in histiocytosis X, which also has diagnostic significance.

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