complete clearance of resistant granuloma faciale with pulsed dye laser after pre-treatment with mometasone and tacrolimus

introduction: granuloma faciale is an uncommon inflammatory dermatosis which usually affects the face and is often resistant to treatment. case report: a 39-year-old english lady with fitzpatrick skin phototype ii presented with typical lesions of granuloma faciale, confirmed on biopsy, on her cheeks and nose. treatment with scleroplus pulsed dye laser (candela corporation, wayland, mass) produced no visible improvement. the patient re-presented 5 years later with the same lesions, now more prominent. no improvement was noted with topical mometasone, however addition of topical tacrolimus caused significant flattening. since the erythema and telangiectases persisted, treatment with scleroplus pulsed dye laser was re-attempted. treatments were performed with a wavelength of 595 nm, pulse duration of 1.5 ms and 7 mm spot at a fluence of 8.5 j/cm2 in the first session and 9.5 j/cm2 in the subsequent 2 sessions. this resulted in complete resolution without scarring or pigmentary change. there was no recurrence at follow-up one year later. conclusion: our observation supports the use of combination therapy in resistant cases of granuloma faciale. one such combination would be the application of a topical corticosteroid and tacrolimus followed by pulsed dye laser.