Successful response to topical tacrolimus for a granuloma faciale in an elderly patient.

plaques, papules or nodules over the dorsa of joints, and GF usually appears as one or a few plaques on the face. In addition, eosinophils and plasma cells are prominent in GF, whereas neutrophils are plentiful in erythema elevatum diutinum [1] . GF is often quite resistant to therapy [2–6] . Topical calcineurin inhibitors may represent a useful alternative to topical corticosteroids for the treatment of a number of other inflammatory skin diseases different from atopic dermatitis [7] . We report a 90-year-old male patient without remarkable medical history who presented to our department with an asymptomatic lesion on the nasal tip. This lesion had been present for 6 months, and gradual enlargement had been observed. Physical examination revealed an oval, well-delimited, reddish yellow plaque, 2.5 ! 1.5 cm in size, with a smooth and brilliant surface. Focal telangiectasia and follicular openings were also found ( fig. 1 ). A biopsy specimen was obtained which showed a dense dermal polymorphous inflammatory infiltrate with neutrophils, lymphocytes, plasma cells and numerous eosinophils. A narrow grenz zone and a mild fibrosis area were also found. With these histological findings, a diagnosis of GF was made. Therapy with topical 0.1% tacrolimus ointment twice daily was started after he had not responded to the application of topical corticosteroids. Treatment was stopped after 3 months with remission lasting for 1 year. Only slight reddish coloration at the edges of the lesion remained ( fig. 2 ). No burning sensation was noted.