Acta Dermato-Venereologica 99-9CompleteContent | Page 24

SHORT COMMUNICATION
833
Granuloma Faciale Treated Successfully with Colchicine
Chika OHATA and Takekuni NAKAMA
Department of Dermatology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan. E-mail: ohata@
med.kurume-u.ac.jp
Accepted Apr 30, 2019; E-published May 2, 2019
Granuloma faciale (GF) is a rare dermatosis that presents
as a single or several brownish red plaques, nodules,
macules and papules on the face. The aetiology of GF is
unclear, and GF is occasionally refractory to treatment.
Topical tacrolimus and glucocorticosteroids are the
mainstay of treatment for GF. Moreover, intralesional and
systemic corticosteroids, topical pimecrolimus, topical
and systemic dapsone, systemic hydroxychloroquine,
clofazimine, tumour necrosis factor-α inhibitors, lasers,
cryosurgery, and surgery have been reported as other
treatment options (1). Colchicine has, surprisingly, been
reported as a treatment option in several articles, despite
the lack of even an anecdotal report (2–5). We report here
a case of GF in which colchicine was effective against
an aggravated lesion following cessation of dapsone,
which was also effective, but was stopped because of
liver injury.
CASE REPORT
A 63-year-old woman presented with a painful, red
plaque on the left cheek, which had gradually enlarged
over a year. The patient was treated with minocycline,
prednisolone, 35 mg/day, and/or topical corticosteroids
before visiting our hospital; however, none of them was
effective. The patient had a positive test result for the
hepatitis C virus (HCV) antibody, whereas liver enzyme
levels were within the normal range. A hepatologist did
not treat the patient because serum HCV RNA was un­
detectable. Physical examination revealed a relatively
well-demarcated dark-red plaque on the left cheek (Fig.
1a). A biopsy from the lesion revealed a dense, diffuse
inflammatory cell infiltrate throughout the dermis with
a narrow, uninvolved grenz zone (Fig. 1e). The infiltrate
consisted of lymphocytes, neutrophils, eosinophils, and
plasma cells, together with extravasated erythrocytes
(Fig. 1f). The blood vessels were dilated in the upper
dermis. In the mid dermis, leukocytoclastic vasculitis
(LCV) with nuclear debris and eosinophilic fibrinoid
material within and around the vessel were seen (Fig.
1g). Fibrosis was also observed. Based on these fin­
dings, the patient was diagnosed with GF, and dapsone,
50 mg/day, was initiated. Although, one month of this
treatment alleviated the pain, the clinical manifestation
Fig. 1. (a) Clinical manifestation at first visit. (b) Improved lesion with dapsone. (c) Recurrence of granuloma faciale after the cessation of dapsone. (d)
Improved lesion with colchicine. (e) Scanning view of a biopsy specimen revealed a dense, diffuse inflammatory cell infiltrate throughout the dermis with
a narrow, uninvolved grenz zone (haematoxylin and eosin (H&E) ×40). (f) The infiltrate consists of lymphocytes, neutrophils, eosinophils, and plasma
cells, together with extravasated erythrocytes (H&E ×40). (g) Leukocytoclastic vasculitis with nuclear debris and eosinophilic fibrinoid material within
and around the vessel in the mid dermis (H&E ×40).
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3209
Acta Derm Venereol 2019; 99: 833–834