Successful Novel Treatment of Granuloma Faciale Using CO2 Emulated Er:YAG Laser Ablation

Kilee Bayne, DO; Brandon E. Fornwalt, DO; Christopher F. Jonda, PAC; Adam D. Cash, MD

Disclosures

Plast Reconstr Surg Glob Open. 2021;9(10):e3847 

In This Article

Abstract and Introduction

Abstract

Summary: Granuloma faciale is a rare, benign inflammatory skin disease that has multiple medical treatment modalities due to its frequent unresponsiveness to treatment. This skin disease presents as a single, well-demarcated red-brown to violaceous, raised lesion, most commonly on the face, in middle-aged White men. Its etiology is unknown; sun exposure is thought to have some implications in its formation. Treatment modalities for granuloma faciale include topical therapy, intralesional injections, systemic therapies, phototherapy, lasers, cryotherapy, and surgical excision. In this article, we will highlight a rare case of granuloma faciale and its novel and successful treatment with a carbon dioxide emulated Er:YAG laser.

Introduction

Granuloma faciale (GF) is a rare, benign, inflammatory skin disease that was first termed by Wigley in 1945, referring to the condition as an eosinophilic granuloma of the skin.[1] Clinically, GF presents as a red-brown to violaceous papule, or plaque, often with superficial telangiectasias, most commonly on the face.[2] The lesions may also present on the trunk, extremities, or in the nasal cavity.[3] Due to the presenting location, it is hypothesized that sun exposure contributes to the formation of these plaques. Demographics of this disease include most commonly middle-aged White men, but it has also been shown to appear in children.[1] Although the exact etiology is unknown, it is commonly classified as an eosinophilic dermatosis.[4] Diagnosis should be made with a biopsy and confirmed histopathologically. Histology of GF shows a dense mixed-cell infiltrate that extends into the papillary dermis but is separated from the epidermis by a narrow zone, referred to as the grenz zone.[5] Typically, eosinophilic infiltrates are seen throughout, but not necessary for the diagnosis. Other histologic findings for GF include neutrophilic infiltration, telangiectasias, and vascular changes.[5] Treatment of GF may be difficult with multiple medical modalities, including topical, systemic, and mechanical treatments. This article will discuss a case of GF and its successful treatment with a carbon dioxide (CO2) emulated Er:YAG laser.

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