Abstract

Erythema elevatum diutinum (EED) and granuloma faciale (GF) are two inflammatory dermatoses whose variable and overlapping features pose a diagnostic challenge. For example, the diagnosis of GF is often based on its predilection for the face, but there are reports of its occurrence solely below the neck. To complicate matters, these cannot be disproven as cases of misdiagnosed EED, as there are no absolute criteria for either. Here, we review their basis as distinct entities and present a case of granuloma faciale notable for its atypical features, association with sarcoidosis, and the etiologic implications thereof. Our patient was a 32-year-old male who presented with diffuse, symmetrically distributed erythematous, pruritic papules sparing the palmoplantar surfaces, concentrated over the face. The rash began following a period of sun exposure and an intervening burning sensation over the affected area. His past medical history was significant for sarcoidosis. A complete blood count revealed eosinophilia (700/mL). Microscopic examination discovered nearly confluent parakeratosis with ulceration, excoriation, and underlying acanthosis. Within the subjacent dermis, a perivascular infiltrate contained disintegrating neutrophils and numerous eosinophils. No Grenz was observed. This is, to our knowledge, the first report of granuloma faciale with prodromal burning and diffuse dissemination. Certain instances of EED and GF may be indistinguishable; however, distinct, consistent patterns, such as those of associations and treatment response, indicate separate pathways. Our patient’s history of sarcoidosis supports involvement of type 1 T helper cells and interferon-gamma in the pathogenesis of GF.