Granuloma faciale as a diagnostic and therapeutic challenge

Introduction:
Granuloma faciale is a rare dermatosis classified within the group of eosinophilic dermatoses, which presents a persistent challenge in both diagnosis and treatment.

Objective:
Presentation a case of granuloma faciale along with a comprehensive discussion of the pathophysiology, clinical presentation, and treatment of the disease.

Case report:
A 68-year-old man presented to a dermatologist with nodular and plaque-like lesions on his face that had been present for 6 months. Initially, based on histopathological findings, fixed drug eruption was diagnosed, and the patient was instructed to discontinue the medications he had been taking, including acetylsalicylic acid and non-steroidal anti-inflammatory drugs. Nevertheless, the skin lesions persisted. Following extended differential diagnosis (including dermoscopy and repeated histopathological examination), the diagnosis of granuloma faciale was established and, consequently, cryotherapy with liquid nitrogen was administered, resulting in a significant improvement in the patient’s skin condition.

Conclusions:
Despite being typically located in the specific areas, granuloma faciale poses diagnostic challenges. Cryotherapy seems to be an effective and safe therapeutic approach in patients who fail to respond to topical medications.