Idiopathic aseptic facial granuloma: A retrospective study of 43 cases.

BACKGROUND: Idiopathic aseptic facial granuloma (IAFG) is an underrecognized pediatric skin disease, currently considered within the spectrum of rosacea. It usually manifests as a solitary, reddish, asymptomatic nodule on the cheek that resolves spontaneously. METHODS: Retrospective and descriptive observational study of 43 pediatric patients with a clinical diagnosis of IAFG, followed between 2004 and 2022, at two general hospitals in Argentina. RESULTS: IAFG predominated in girls (65%) and the average age of onset was about 6 years. A single asymptomatic nodule was seen in 79% of patients. The most common localization was the cheek (58%) followed by lower eyelids (41%). Family history of rosacea was present in 16% of patients. A concomitant diagnosis of rosacea and periorificial dermatitis was made in 14% and 9% of our population, respectively. Past or present history of chalazia was detected in 42% of the children. IAFG diagnosis was mainly clinical (88% of cases). Oral antibiotics were the most common indicated treatment (84%). Complete healing was achieved by the majority, but 18% of those with eyelid compromise healed with scars. CONCLUSIONS: IAFG is a benign pediatric condition that physicians should recognize in order to manage correctly. We herein refer to a particular morphologic aspect of IAFG lesions affecting the lower eyelids, where nodules adopt a linear distribution and have a higher probability of involute leaving a scar. Also, we consider that the concomitant findings of rosacea, periorificial dermatitis and chalazia in our patients, reinforce the consideration of IAFG within the spectrum of rosacea.

Hamartoma folicular basaloide / Basaloid follicular hamartoma

O hamartoma folicular basaloide (HFB) é um tumor anexial raro e benigno, que se assemelha ao carcinoma basocelular (CBC), e pode apresentar manifestações clínicas diversas. Uma mutação no gene PTCH, envolvido na síndrome de Gorlin-Goltz, poderia estar associada à patogênese dessa neoplasia. Descreve-se caso de menina, sete anos, apresentando múltiplas pápulas na face.

Basaloid follicular hamartoma (BFH) is a rare and benign adnexal tumor that resembles basal cell carcinoma (BCC) and may present with different clinical manifestations. A mutation in the PTCH gene, involved in Gorlin-Goltz syndrome, could be associated with the pathogenesis of this neoplasm. We describe the case of a 7-year-old girl with multiple papules on her face.

The use of retinoic acid in association with microneedling in the treatment of epidermal melasma: efficacy and oxidative stress parameters.

This study aimed to evaluate the effectiveness of isolated treatment with retinoic acid and its combination with the microneedling technique in facial melasma, seeking to associate these results with possible oxidative damage. This is a blinded randomized clinical trial with 42 women with facial melasma (skin phototype I-IV), randomized into Group A (microneedling and 5% retinoic acid) or Group B (5% retinoic acid alone). Four procedures were applied with 15 days intervals (4 blood collections). Clinical improvement was assessed using the Melasma Area Severity Index (MASI). Serum oxidative stress levels were evaluated by protein oxidation (carbonyl), lipid peroxidation (TBARS) and sulfhydryl groups, as well as enzyme activities of superoxide dismutase (SOD) and catalase (CAT). The statistical analyzes were performed by generalized estimation equation (GEE). There was a reduction in MASI scale and TBARS levels in both groups over time (p < 0.05), with no difference between groups (p = 0.416). There was also a substantial increase in the carbonyl levels at 30 days (p = 0.002). The SOD activity decreased after 30 days, regardless of group (p < 0.001), which was maintained after 60 days. In Group A, there was a reduction in sulfhydryl levels at 60 days (p < 0.001). It is important to highlight that both groups demonstrated efficacy in the clinical improvement of melasma within at least 60 days, reducing the MASI score by almost 50%. However, microneedling with retinoic acid seems to be the worst treatment because there is a reduction in the non-enzymatic antioxidant defense, which is important to protect against oxidative stress.

Case for diagnosis. Eyelid edema and erythematous papules disseminated on the face

Abstract Lupus miliaris disseminatus faciei or acne agminata is a chronic inflammatory disorder of the skin, considered an intriguing entity due to its pathogenesis, which is still largely speculative. It has been linked to tuberculosis, sarcoidosis, rosacea, and other granulomatous diseases, but it is considered an independent entity.

Case for diagnosis. Eyelid edema and erythematous papules disseminated on the face.

Lupus miliaris disseminatus faciei or acne agminata is a chronic inflammatory disorder of the skin, considered an intriguing entity due to its pathogenesis, which is still largely speculative. It has been linked to tuberculosis, sarcoidosis, rosacea, and other granulomatous diseases, but it is considered an independent entity.

Respuesta quirúrgica del síndrome de Favre-Racouchot / Surgical response of Favre-Racouchot Disease

Introducción: el síndrome de Favre-Racouchot es una elastosis cutánea, de localización preferentemente periorbitaria, causada por la exposición crónica al sol. Se caracteriza por la aparición de lesiones amarillentas sobreelevadas y múltiples comedones.Objetivo: presentar el caso de un paciente diagnosticado del síndrome de Favre-Racouchot, al que se le realizó tratamiento quirúrgico y médico con resultados satisfactorios.Presentación de caso: paciente blanco, masculino, de 58 años, natural de una zona rural y trabajador agrícola, fumador por más de 20 años, con una historia de fotoexposición crónica desde la adolescencia hasta la actualidad. Acudió a la consulta de dermatología por presentar lesiones cutáneas que no le producían síntomas, pero tenían repercusión estética. El cuadro cutáneo era localizado, bilateral y asimétrico, constituido por pápulas confluentes y nódulos quísticos, agrupados sobre una piel atrófica de tono amarillento, arrugas profundas y grandes comedones negros -en número de centenas- localizados en las regiones temporal y periorbitaria, sin inflamación. Ante esta situación se decidió tratamiento médico y quirúrgico.Conclusiones: los factores causantes del síndrome de Favre- Racouchot en este paciente fueron la fotoexposición prolongada, sin la protección correcta, y el hábito de fumar. Aunque por lo general la autoplastia de vecindad por deslizamiento frontal no se emplea en los casos con lesiones grandes y flacidez de la piel en las áreas afectadas, en este los resultados fueron satisfactorios. Luego de la intervención quirúrgica es importante que el paciente haga cambios en su estilo de vida y se le mantenga el seguimiemto especializado(AU)

Introduction: Favre-Racouchot disease is a cutaneous elastosis, which affects preferably periorbital region, caused by chronic sun exposure. It is characterized by the appearance of raised yellowing lesions and multiple comedones.Objective: to present the case of a patient diagnosed with Favre-Racouchot disease, who underwent surgical and medical treatment with satisfactory results.Case presentation: white, male, 58-year-old patient from a rural area and agricultural worker, smoker for more than 20 years, with a history of chronic photo-exposure from adolescence to the present. He went to the dermatology office for presenting skin lesions that did not produce symptoms, but had aesthetic repercussions. The cutaneous picture was localized, bilateral and asymmetric, consisting of confluent papules and cystic nodules, grouped on a yellowish atrophic skin, deep wrinkles and large black comedones located in the temporal and periorbital regions, without inflammation. Given this situation, medical and surgical treatment is decided.Conclusions: the factors causing Favre-Racouchot disease in this patient were prolonged photo-exposure, without the correct protection, and smoking. Although in general the neighborhood sliding autoplasty is not used in cases with large lesions and sagging skin in the affected areas, in this patient the results were satisfactory. After surgery, it is important that the patient make changes in his lifestyle and stay with the specialized follow-up(AU)

Facial involvement and the severity of psoriasis.

BACKGROUND: Psoriasis is a chronic, inflammatory skin disorder characterized by well-demarcated erythematous-scaly lesions, affecting 0-6.6% of the world population. Facial lesions are neglected in most descriptions in current literature, although some studies indicate that it could be a predictor of psoriasis severity. OBJECTIVE: To compare the severity of psoriasis, measured by the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI), in patients with and without facial lesions. MATERIAL AND METHODS: This is a cross-sectional study, whose sample size was 63 individuals for each group. Subjects were included in the HUPES Complex Dermatology Service (Salvador/BA - Brazil) from April 2014 to January 2016. Demographic information was obtained using a prestructured form. Assessments of psoriasis severity and quality of life were done using PASI and DLQI, respectively. RESULTS: Facial lesions were detected on 63 (50.0%) of the 126 patients included. The pinna was the most frequently affected region (63.5%). Mean PASI in the group with facial involvement was 14.0 vs. 6.0, when facial involvement was absent. DLQI means for these groups were, respectively, 7.5 and 4.7. CONCLUSIONS: Facial involvement in a psoriasis patient was a marker of disease severity, and its identification should influence the therapeutic decision.

Keratosis lichenoides chronica: First case reported in Chile.

We present a woman with a history of years of evolution of confluent hyperkeratotic papules and plaques with a generalized linear and reticulate pattern. Histopathological characteristics concordant with keratosis lichenoides chronica were finally evidenced after several non-specific biopsies. The cutaneous manifestations, chronicity. histopathology findings, and refractoriness to therapies are typical of this rare dermatosis.

Idiopathic Facial Aseptic Granuloma: Updated Review of Diagnostic and Therapeutic Difficulties. / Granuloma aséptico facial idiopático: revisión actualizada de las dificultades diagnósticas y terapéuticas.

Idiopathic facial aseptic granuloma is a pediatric skin condition involving asymptomatic reddish nodules. The etiology and pathogenesis is still under discussion, although the literature tends to place this condition within the spectrum of childhood rosaceas. The clinical course is chronic but benign, and cases have been reported to resolve spontaneously in less than a year. Even though no well-defined treatment has emerged, a conservative approach that avoids aggressive therapies is preferred.

Rosácea infantil.

Background: Rosacea is a chronic inflammatory skin condition that usually occurs in adults and rarely has been reported in children, although both subtypes share the same clinical characteristics. Case report: A 10-year-old female presented dermostosis on the face, affecting cheeks and nose, characterized by erythema, papules, pustules, scars of two years of evolution, as well as bilateral conjunctivitis, blepharitis and corneal opacity. She referred recurrent exacerbations and partial remission of cutaneous lesions and ocular symptoms related to sun exposure. She responded dramatically to systemic and topical antibiotics. Conclusions: Childhood rosacea should be distinguished from other most common erythematous facial disorders, such as acne, granulomatous perioral dermatitis, and sarcoidosis. The distribution of papulopustular facial lesions together with the presence of telangiectasia, flushing and the ocular findings allow the differentiation of rosacea from other facial eruptions.

Introducción: La rosácea es una enfermedad inflamatoria crónica de la piel que generalmente afecta adultos. Rara vez se ha reportado en niños, aunque ambos subtipos comparten las mismas características clínicas. Caso clínico: Se reporta el caso de una paciente de 10 años de edad con dermostosis que afecta las mejillas y la nariz. La lesión está caracterizada por eritema, pápulas, pústulas, cicatrices de 2 años de evolución, así como conjuntivitis bilateral, blefaritis y opacidad corneal. Presentó exacerbaciones recurrentes de las lesiones cutáneas y síntomas oculares relacionados con la exposición solar. La paciente respondió muy bien a la terapia con antibióticos tópicos y sistémicos. Conclusiones: La rosácea infantil debe distinguirse de otros trastornos faciales eritematosos con mayor frecuencia, como el acné, la dermatitis perioral granulomatosa y la sarcoidosis. La distribución de las lesiones faciales papulopustulares junto con la presencia de telangiectasias, rubor y los hallazgos oculares permiten la diferenciación de la rosácea de otras erupciones faciales.

[Idiopathic facial aseptic granuloma: A case report]. / Granuloma aséptico facial idiopático: A propósito de un caso.

Idiopathic facial aseptic granuloma is a childhood condition characterized by asymptomatic erythematous-violaceous nodules, often confused with abscesses. Its pathogenesis is unknown, but some authors have postulated its relationship with infantile rosacea. We present a case of a patient with a clinical diagnosis of idiopathic facial aseptic granuloma, with ocular involvement and a good response to oral metronidazole treatment.

El granuloma aséptico facial idiopático (GAFI) es una afección de la infancia, que se caracteriza por nodulos faciales eritematovioláceos asintomáticos, usualmente confundidos con abscesos. Su patogénesis es desconocida, pero algunos autores han postulado su relación con la rosácea infantil. Se presenta el caso de un paciente con diagnóstico clínico de granuloma aséptico facial idiopático, con compromiso ocular y buena respuesta al tratamiento con metronidazol por vía oral.

[A case report of granuloma faciale, an uncommon cutaneous vasculitis]. / Reporte de caso de granuloma facial, una vasculitis cutánea infrecuente.

Granuloma faciale is an uncommon benign dermatosis, with unknown etiology, usually asymptomatic, characterized by chronic inflammation localized in sun-exposed areas of the face with a characteristic histological pattern. Although response to treatment is variable, there are multiple therapeutic alternatives that have been reported to be effective in some patients, including systemic treatments with steroids and dapsone or also topical treatments like intralesional corticosteroid, cryotherapy and calcineurin inhibitors, such as tacrolimus. We present the case of an adult patient with an asymptomatic erythematous-violet plaque on the right cheek, with progressive slow growth over two years, clinically and histologically and pathologically compatible with a facial granuloma. The patient responded well to intralesional corticosteroids.

El granuloma facial es una dermatosis benigna poco frecuente de etiología desconocida, generalmente asintomática, caracterizada por inflamación crónica y localizada habitualmente en zonas fotoexpuestas de la cara, con un patrón histológico característico. Si bien la respuesta al tratamiento es variable, existen múltiples opciones terapéuticas que han reportado ser efectivas en algunos pacientes. Entre estas alternativas se incluyen tratamientos sistémicos con corticoides y dapsona o tratamientos intralesionales con corticoides, crioterapia e inhibidores de calcineurina tópicos. Describimos el caso de un paciente adulto con una placa eritemato violácea asintomática en mejilla derecha, de crecimiento lentamente progresivo de dos años de evolución, clínica e histopatológicamente compatible con granuloma facial y respuesta favorable a corticoides intralesionales.

Reporte de caso de granuloma facial, una vasculitis cutánea infrecuente / A case report of granuloma faciale, an uncommon cutaneous vasculitis

El granuloma facial es una dermatosis benigna poco frecuente de etiología desconocida, generalmente asintomática, caracterizada por inflamación crónica y localizada habitualmente en zonas fotoexpuestas de la cara, con un patrón histológico característico. Si bien la respuesta al tratamiento es variable, existen múltiples opciones terapéuticas que han reportado ser efectivas en algunos pacientes. Entre estas alternativas se incluyen tratamientos sistémicos con corticoides y dapsona o tratamientos intralesionales con corticoides, crioterapia e inhibidores de calcineurina tópicos. Describimos el caso de un paciente adulto con una placa eritemato violácea asintomática en mejilla derecha, de crecimiento lentamente progresivo de dos años de evolución, clínica e histopatológicamente compatible con granuloma facial y respuesta favorable a corticoides intralesionales.

Granuloma faciale is an uncommon benign dermatosis, with unknown etiology, usually asymptomatic, characterized by chronic inflammation localized in sun-exposed areas of the face with a characteristic histological pattern. Although response to treatment is variable, there are multiple therapeutic alternatives that have been reported to be effective in some patients, including systemic treatments with steroids and dapsone or also topical treatments like intralesional corticosteroid, cryotherapy and calcineurin inhibitors, such as tacrolimus. We present the case of an adult patient with an asymptomatic erythematous-violet plaque on the right cheek, with progressive slow growth over two years, clinically and histologically and pathologically compatible with a facial granuloma. The patient responded well to intralesional corticosteroids.

Dermoscopy of granuloma faciale: a description of a new finding.

Granuloma faciale is a rare, chronic dermatologic disorder, which mainly affects the face. Recently, dermoscopy has been demonstrated as an important ancillary tool on the clinical diagnosis of facial dermatoses. We report two cases of granuloma faciale with yellow areas on dermoscopy that was not yet described in the literature, corresponding to abundant hemosiderin on histopathological examination.