Fig. 12.1
Upper panel reveals reddish, smooth edematous plaques over the face. Histological examination revealed primary follicular mucinosis. Lower panel reveals a solitary orangish, smooth nodular plaque. Histological examination confirmed the diagnosis of granuloma faciale
Case
A patient presents with one or few infiltrated facial plaques and/or nodules.
Clinical differential diagnosis consists of
acute discoid lupus erythematosus (DLE)
tumid lupus erythematosus TLE
Jessner benign lymphocytic infiltration of the skin (JBLI)
lymphocytoma cutis (also known as pseudolymphoma of Spiedler and Fendt)
sarcoidosis
granuloma faciale (GF)
follicular mucinosis and -B-cell lymphoma (BCL).
In endemic areas, lupus vulgaris, Leishmania recidivans, subcutaneous and systemic fungal infection, and extranodal NK-cell lymphoma nasal type may be considered but will not be discussed here.
Clinical Clues
None of the above disorders is symptomatic to any significant degree. Both, sarcoidosis and DLE are seen more commonly among black populations in the USA, but the remaining disorders do not favor race, age, or ethnicity.
Sarcoidosis of the face tends to favor mucocutaneous junctions of the lips, nares, and eyes. The remaining disorders affect various areas of the face equally.
All the above disorders except sarcoidosis and follicular mucinosis strongly favor the face and may be limited to the face.
Lymphocytoma cutis, B-cell lymphoma, and GF are all more likely to present as a solitary lesion.
Lymphocytoma cutis and B-cell lymphoma present with nodules while DLE, BLI, and follicular mucinosis are more likely to present as plaques. GF and sarcoidosis present as nodules or plaques, and sometimes nodular plaques.
B-cell lymphoma is likely to be a plum-colored nodule or tumor, lymphocytoma cutis a red nodule, GF as an orange nodular plaque, BLI as pink to red plaques and papules, some annular, follicular mucinosis as faintly pink discrete and confluent papules, sarcoidosis as apple jelly papules, and DLE as reddish to purplish plaques with active borders. The surface of all disorders is smooth except an old lesion of DLE, which often acquires both follicular and diffuse scaling.