A nose for trouble

Patta, Federico; Milo, Carla; Pilloni, Luca; Atzori, Laura

doi:10.4103/0378-6323.148604

Indian J Dermatol Venereol Leprol

2015

DOI: 10.4103/0378-6323.148604

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A nose for trouble

Federico Patta¹,

Carla Milo²,

Luca Pilloni³

et al.

Abstract: A 63-year-old Caucasian non-smoker presented with purplish, firm, slowly growing plaques on the nose, of 20 years duration. The bigger one involved the upper part of the nose in its entirety [ Figure 1], while there were smaller ones on the left and right cheek. All the plaques were asymptomatic and did not worsen after sunlight exposure. His past medical history was unremarkable. Hematological and biochemical parameters were within normal limits. Histological

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2021

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Rhinophyma‐like granuloma faciale

Allegue

Fachal

González‐Vilas

et al. 2021

Dermatologic Therapy

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Granuloma faciale (GF) is a rare, chronic and asymptomatic inflammatory dermatosis characterized by papules, nodules, or plaques of facial location. Color varies from pink to reddish brown or purplish. It is considered a peculiar and chronic form of vasculitis, with a good prognosis and without systemic repercussions. 1,2 We present here a case of GF simulating a rhinophyma.A 60-year-old man, with past history of kidney transplant between 1997 and 2017 due to IgA glomerulonephritis and currently on dialysis due to atypical hemolytic uremic syndrome (aHUS), consulted for papular and nodular skin lesions that changed the contour of his nose. First symptoms appeared on 1999, and diagnosis of GF was made. The condition appeared despite being on immunosuppressive treatment due to his kidney transplant with cyclosporine A, mycophenolate mofetil, and prednisone. Powerful and intralesional topical corticosteroids were then tested without therapeutic response. Acceptable cosmetic results were obtained with cryosurgery, which persisted until 2 years ago, when he noted worsening of previous lesions. In 2015, cyclosporine A was replaced by tacrolimus due to chronic graft dysfunction and in 2017 eculizumab was started after the diagnosis of aHUS.Physical examination showed raised-pinkish papules appeared on a thickened and shiny skin with follicullar accentuation of the nose (Figure 1). Despite the fact that the patient already had a histopathological diagnosis of GF, two new skin biopsies (nodule and nasal tip) were performed. These showed diagnostic changes of GF (Figures 2 and 3).We performed again cryosurgery, three freeze-thaw cycles of 20 to 30 s at 1-month intervals. We achieved an acceptable cosmetic result without pigmentary changes or scarring (Figure 4). In the 6-month follow-up, there were no signs of recurrence.Granuloma faciale is a fairly predictive process in its presentation.

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Rhinophyma‐like granuloma faciale

Allegue

Fachal

González‐Vilas

et al. 2021

Dermatologic Therapy

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A nose for trouble

Cited by 1 publication

References 5 publications

Rhinophyma‐like granuloma faciale

Rhinophyma‐like granuloma faciale

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