Successful Treatment of Granuloma Faciale with Topical Tacrolimus: A Case Report and Immunohistochemical Study

Tojo, Gen Ichi; Fujimura, Taku; Kambayashi, Yahiko; Kikuchi, Katsuko; Aiba, Setsuya

doi:10.1159/000341196

Cited by 9 publications

(5 citation statements)

References 13 publications

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“…8 While it has a favorable side-effect profile, most reports demonstrate incomplete resolution with this agent. [8][9][10] There are isolated case reports on the use of systemic agents such as dapsone, colchicine, anti-malarials, isoniazid and clofazimine; however, they are neither consistently effective nor without risks of adverse effects. 2,3 Various lasers have been used to treat granuloma faciale, with variable efficacy.…”

Section: Discussionmentioning

confidence: 99%

Complete Clearance of Resistant Granuloma Faciale With Pulsed Dye Laser After Pre-treatment With Mometasone and Tacrolimus

Micallef

Boffa

2017

J Lasers Med Sci

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IntroductionGranuloma faciale is an uncommon, idiopathic, inflammatory dermatosis that usually affects the face.1 Despite its benign nature, the condition tends to be persistent, can be cosmetically distressing and is notoriously difficult to eradicate completely. 2 We report a case of successful treatment of granuloma faciale using 595-nm pulsed dye laser following topical mometasone and tacrolimus. Case PresentationA 39-year-old English lady with Fitzpatrick skin phototype II, presented to our Dermatology Department with 3 sharply-demarcated, reddish-brown, indurated plaques with accentuated follicular openings and few superficial telangiectases. These were present on both cheeks and the tip of the nose. The patient had been previously diagnosed with granuloma faciale in the United Kingdom 6 months previously and was started on dapsone 50 mg daily, to which there was no visible response. The patient then moved to Malta where dapsone was stopped and the lesion on the right cheek biopsied. The biopsy showed a dense neutrophilic and eosinophilic infiltrate within the papillary and reticular dermis, with a prominent Grenz zone, confirming the diagnosis of granuloma faciale. At this point, treatment with pulsed dye laser was attempted. A test area in the right cheek lesion underwent two treatments with a ScleroPlus pulsed dye laser (Candela Corporation, Wayland, Mass) with cryogenspray dynamic cooling. A wavelength of 595 nm and pulse duration of 1.5 ms were used, with a 7 mm spot at a fluence of 8.5 J/cm 2 for the first session and 9.5 J/ cm 2 for the second session, carried out after an interval of 8 weeks. There was no visible improvement with this treatment. The patient was lost to follow-up but re-presented 5 years later with the same lesions, which by then had become more prominent. She was prescribed mometasone 0.1% ointment once daily for 2 months, with no visible improvement. Tacrolimus 0.1% ointment twice daily was then added to the mometasone ointment for another 2 Case Report Abstract Introduction: Granuloma faciale is an uncommon inflammatory dermatosis which usually affects the face and is often resistant to treatment. Case Report: A 39-year-old English lady with Fitzpatrick skin phototype II presented with typical lesions of granuloma faciale, confirmed on biopsy, on her cheeks and nose. Treatment with ScleroPlus pulsed dye laser (Candela Corporation, Wayland, Mass) produced no visible improvement. The patient re-presented 5 years later with the same lesions, now more prominent. No improvement was noted with topical mometasone, however addition of topical tacrolimus caused significant flattening. Since the erythema and telangiectases persisted, treatment with ScleroPlus pulsed dye laser was re-attempted. Treatments were performed with a wavelength of 595 nm, pulse duration of 1.5 ms and 7 mm spot at a fluence of 8.5 J/cm2 in the first session and 9.5 J/cm 2 in the subsequent 2 sessions. This resulted in complete resolution without scarring or pigmentary change. There was no recurrence at follow-up ...

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Section: Discussionmentioning

confidence: 99%

Complete Clearance of Resistant Granuloma Faciale With Pulsed Dye Laser After Pre-treatment With Mometasone and Tacrolimus

Micallef

Boffa

2017

J Lasers Med Sci

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“…[1] The histopathology is diagnostic and shows a dense mid-dermal cellular infiltrate rich in eosinophils, with a sub-epidermal Grenz zone, leukocytoclastic vasculitis, and fibrosis. [3] The name of the disease was proposed by Pinkus, although it was first described by Lever and Leeper in 1950. [1] Histologically, there is no granulomatous inflammation, thus the term is actually a misnomer.…”

Section: Discussionmentioning

confidence: 99%

A nose for trouble

Patta¹,

Milo²,

Pilloni³

et al. 2015

Indian J Dermatol Venereol Leprol

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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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“…As in our previous report suggested [6], we treated all cases with topical administration of tacrolimus ointment, which is reported to increase the number of IL-10-producing cells and enhance the production of TGF-β [7], which might suppress the production of proinflammatory cytokines. In one of our present cases, indeed, the eruption diminished during two months of topical administration of 0.1% tacrolimus.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Plasmacytosis Circumorificialis with Topical Tacrolimus: Two Case Reports and an Immunohistochemical Study

et al. 2013

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Plasmacytosis circumorificialis (PLC), a benign chronic inflammatory disease with an unknown pathogenesis, is characterized by erythema, erosion nodules and ulcers around the openings of the human body. In this report, we describe two cases of PLC successfully treated with topical tacrolimus. Interestingly, immunohistochemical staining revealed that prominent CD163⁺ proinflammatory macrophages and IL-17-producing cells were infiltrating around plasma cells, which might suggest the reason for the therapeutic effect of topical tacrolimus on PLC.

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Successful Treatment of Granuloma Faciale with Topical Tacrolimus: A Case Report and Immunohistochemical Study

Cited by 9 publications

References 13 publications

Complete Clearance of Resistant Granuloma Faciale With Pulsed Dye Laser After Pre-treatment With Mometasone and Tacrolimus

Complete Clearance of Resistant Granuloma Faciale With Pulsed Dye Laser After Pre-treatment With Mometasone and Tacrolimus

A nose for trouble

Successful Treatment of Plasmacytosis Circumorificialis with Topical Tacrolimus: Two Case Reports and an Immunohistochemical Study

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