Treatment of granuloma faciale with the 585-nm pulsed dye laser.

A 41-year-old white man with a long history of acne rosacea was referred for evaluation of a persistent erythematous lesion on his nose. The lesion had been present for 2 years and had proved resistant to topical and oral antibiotic therapy. Examination of the patient’s face revealed malar erythema, scattered acnei form papules , and an absence of comedones, consistent with mild acne rosacea. On the dorsum of the nose, there was a discrete 2-cm, reddish-brown, indurated plaque with prominent telangiectasias (Figure 1). The clinical differential diagnosis included granuloma faciale, sarcoidosis, and discoid lupus erythematosus. Histopathologic findings were consistent with granuloma faciale and revealed a mixed infiltrate in the papillary and reticular dermis composed of neutrophils, eosinophils, plasma cells, lymphocytes, and monocytes. There was an overlying Grenz zone noted, as well as associated leukocytoclastic vasculitis.