Granulosis rubra nasi: a rare condition treated successfully with topical tacrolimus

Abstract

A 20 years-old girl presented with multiple asymptomatic reddish vesicles on face for four years. It used to get worse in summer and was associated with localized hyperhidrosis. The lesions were notable for disappearance on diascopy. Histopathology from the vesicle showed mononuclear cell infiltration in the upper dermis, especially around eccrine sweat apparatus, along with dilatation of superficial capillaries and lymphatics. Based on clinical presentation and histopathology, diagnosis of Granulosis rubra nasi (GRN) was made. GRN usually resolves at puberty; however, rarely it may persist in adulthood. We here report a case of GRN having lesions persisting in adulthood. Moreover, she showed excellent response to topical tacrolimus, a finding not observed in literature.

Granulosis Rubra Nasi: A Case Report and Brief Review of the Literature

“…At times, afected patients may have associated poor peripheral circulation and hyperhidrosis of the palms and soles [8]. Summer aggravation of lesions is occasionally found [8].…”

“…Piotr and Katarzyna have described a 14-year-old patient that responded well to low-dose isotretinoin [12], and Kumar et al reported that topical tacrolimus has been effective in decreasing vesicles in a 20-year-old patient who has had GRN [8].…”

Granulosis Rubra Nasi Response to Topical Tacrolimus

“…Erythema may gradually extend to involve upper lip, cheeks, and chin with sweat droplets studded over, giving glistening appearance. Small erythematous macules, papules, vesicles, or pustules lesions can also be seen [ 2 , 8 ]. These lesions disappear on diascopy and reappear on relieving pressure [ 2 ].…”

“…Association with primary palmoplantar hyperhidrosis, acrocyanosis, and poor peripheral circulation was observed. Kumar et al had reported an association with another eccrine gland disorder, hidrocystoma [ 8 ]. Heid et al had reported an association with rhinorrhea [ 11 ].…”

“…Systemic corticosteroids help by reducing the inflammatory infiltrate around sweat glands. Topical tacrolimus has been used in low dose, 0.03%, with excellent response [ 8 ].…”