Henry Foong FRCP, Ipoh, Malaysia
on 10 Feb 2002
Consultant Dermatologist, Foong Skin Specialist Clinic, Ipoh, Malaysia
The patient is a 64-yr-old man with a 2 months history of a mildly pruritic eruption on the cheeks and temples. He is otherwise well and has no systemic symptoms. His symptoms were aggravated by sun exposure.
Medical history: hypertension and is on following drugs. Kerlone 10mg daily (beta blocker, Blocadren, Corgard, Lopressor, Sectral, Tenormin, Visken) Nifedipine 10mg bd (calcium channel blocker, Adalat, Procardia)
Exam showed few well defined dusky colored erythematous plaques on the left cheek, temple and upper right cheek. The size of the plaques ranged from 0.5 to 2.5cm. Some of the lesion appeared nodular and hyperpigmented.
Rest of examination was unremarkable.
Here are the photomicrographs from the histopath:
Andrew Carlson MD, Assoc Professor of Dermatopathology,Albany Medical College, Albany, NY, USA.
Based on this small and limited sample (cannot move field around nor go from low to high or high to low magnification- too granular), my differential diagnosis lies between a chronic photosensitivity dermatitis or granuloma faciale. I favour the later due to the apparent fibrosis of the dermis in conjunction with rare nuclear debris and plasma cells surrounding vessels in the high power magnification. Granuloma faciale is chronic, localized and fibrosing variant of leukocytoclastic or small vessel neutrophilic vasculitis. The former dx of a photo eruption is brought in the ddx because of spongiotic reaction pattern, deep infiltrate and location on facial skin