Facial granuloma: causes, symptoms, diagnosis, treatment

Facial granuloma (syn: facial granuloma eosinophilic) is a rare disease of unclear etiology. In the development of face granuloma, the role of trauma, immune and allergic reactions, increased sensitivity to light is assumed. The clinical picture is characterized by one or several sharply outlined stagnant-cyanotic spots with a brownish tinge and a smooth surface, often with widened funnels of hair follicles, small telangiectasias. The most frequent localization - the nose, cheeks, forehead, in other places are very rare. In addition to spots, sometimes there can be nodular-plaque and knotty elements.

Pathomorphology of face granuloma. In fresh elements in the upper part of the dermis, a polymorphic cell infiltrate is identified, separated from the epidermis by a strip of unaltered collagen. The infiltrate consists mainly of neutrophilic and eosinophilic granulocytes, among which there are lymphocytes, histiocytes, plasmocytes and tissue basophils in various amounts. There are extravases of erythrocytes. The result of which are hemosiderin deposits, which, in some cases, cause a brownish coloration of the foci. The number of eosinophils varies, in some cases they occupy most of the infiltration, in others they are few. Always find changes in the vessels, sometimes the fibrinoid necrosis, around which there are accumulations of neutrophilic granulocytes with the phenomena of decay and the formation of "nuclear wasps". In old foci infiltration is less expressed, fibrosis of the dermis with proliferation of fibroblasts is observed. Changes in the vessels are characterized by fibrosis, sometimes with hyaline deposition. A similar histological picture gives grounds for attributing this disease to vasculitis.

Histogenesis. The data of immunofluorescence study of the skin to the lesions also testify to the vascular lesion. AL Schroeter et al. (1971) found deposits of IgG, IgM. IgA, fibrin and complement in the zone of the dermoepidermal basal membrane and around the vessels with direct immunofluorescence. S. Wieboier and GL Kalsbeek (1978) revealed granular deposits of the complement component IgG and C3 along the dermoepidermal zone near the vessels, where other immunoreactants of complement and fibrin were also found.

With electron microscopy, a lot of eosinophils and histiocytes were detected in the infiltrate, and in their cytoplasm - Charcot-Leiden crystals, which are an ultrastructural marker of face granuloma. Clusters of eosinophils with decay phenomena near the vessels secrete enzymes that damage the blood vessels and a chemotactic factor for histiocytes. Histiocytes with face granuloma do not contain Langerhans granules, in contrast to those with histiocytosis X, which also has diagnostic significance.

[1], [2], [3], [4], [5], [6], [7], [8]