Granuloma faciale: efficacy of cryosurgery in 2 cases.

Background. Granuloma faciale is a rare condition of unknown pathogenesis. Treatment often gives less than satisfactory results. We report two cases s uccessfully treated with cryosurgery. Case report. A 42-year-old woman had a round 65 x 40 mm erythematous violet -colored papulous plaque on the right cheek. Histology reported a dense inf lammatory infiltration of the superficial and mid derma around dilated vess els under a normal epidermis. The infiltration was composed of histiocytes, lymphocytes, plasma cells, neutrophils and eosinophils and was compatible with granuloma faciale. Surgical treatment was performed but was followed b y recurrence within a few months. Class I local steroids, cotton swab cryot herapy and oral dapsone remained ineffective. Cryosurgery however led to cu re without recurrence at 1 year follow-up. The second patient was a 52-year old man with an oval reddish-brown papulous plaque on the right preauricul ar area. The plaque measured 40 mm in diameter and histology favored granul oma faciale. Three cotton swab cryotherapy sessions and one surgical excisi on procedure were followed by recurrence. Cryosurgery provided successful c ure without recurrence at 3.5 years follow-up. Discussion. Most destructive treatments for granuloma faciale, including pu lverization cryotherapy, surgery, and CO2 or argon laser are unsuccessful i n preventing recurrence. Cryosurgery was proposed in 1977 but few cases hav e been reported since. Medical treatments have been variously successful wi th most authors reporting unsatisfactory results. In our two cases, surgica l excision was rapidly followed by recurrence and in one case dapsone was i neffective. Cryosurgery provided rapid regression of the lesion and recurre nce-free cure at 1 and 3.5 years follow-up respectively. Cryosurgery is an effective treatment for readily recurrent eosinophilic granuloma faciale an d should be proposed as first intention therapy.