Granuloma Faciale: Exclusively Extrafacial
A 60-year-old man patient presented with multiple persistent asymptomatic erythematous nodules and plaques over dorsum of fingers and toes of both the extremities since last 8 months without any surface changes []. There was no history of pain and redness on cold exposure, arthralgia, or features suggestive of systemic involvement, without any surface changes. The lesions did not show spontaneous regression.\nOn cutaneous examination, there was no tenderness and the lesions were free from the underlying structures. No other site was involved including the face and mucosa. General and systemic examination was unremarkable. A provisional diagnosis of erythema elevatum diutinum was made. Patient was put on dapsone 100 mg/d but did not show any significant response even after 2 months.\nHistopathological examination of one of the lesions revealed hyperkeratosis, hypergranulosis with prominent Grenz zone and a dense polymorphous infiltrate of neutrophils, lymphocytes, plasma cells and very few eosinophils in the dermis []. A diagnosis of GF was thus made.\nAll routine investigations were within normal limits.