Case and Research Letters
Idiopathic Facial Aseptic Granuloma
Granuloma aséptico facial idiopático
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Hiraldo-Gamero, Á. Vera-Casaño, A. Sanz-Trélles" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Hiraldo-Gamero" "email" => array:1 [ 0 => "alihiraldo@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Á." "apellidos" => "Vera-Casaño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Sanz-Trélles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Dermatología, Hospital de Mérida, Badajoz, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología Médico Quirúrgica, HRU Carlos Haya, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, HRU Carlos Haya, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding Author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Granuloma aséptico facial idiopático" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1188 "Ancho" => 1583 "Tamanyo" => 134921 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Asymptomatic red to violaceous nodule in the upper region of the left cheek.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Idiopathic facial aseptic granuloma (IFAG) is a pediatric condition first described in 1999 by a group of French dermatologists who used the name <span class="elsevierStyleItalic">pyodermite froide</span> because of the lesion's resemblance to an abscess, although with mild signs of inflammation.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The condition is characterized by the appearance of 1 or more painless red to violaceous nodules on the face, typically located on the cheeks or eyelids.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The lesions are benign, last from a few months to a year, and usually heal without leaving a scar.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Histologic examination reveals a granulomatous inflammatory response similar to that observed in granulomas caused by foreign bodies or infectious agents such as mycobacteria.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Ultrasound studies reveal a solid hypoechoic lesion without calcium deposits.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 2-year-old girl with no past medical history of interest who was referred to our clinic because of an asymptomatic nodular lesion on the left cheek that had appeared approximately 2 months before the consultation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Physical examination revealed a red to violaceous nodule of approximately 1<span class="elsevierStyleHsp" style=""></span>cm in diameter; the painless lesion was nonfluctuant on palpation and no regional lymph node involvement was observed. When questioned, the infant ‘s mother did not recall any insect bite or trauma at the site.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Cultures for bacteria, fungi, and mycobacteria were negative. Histopathologic study of a 3-mm punch biopsy of the lesion revealed marked inflammation affecting the full thickness of the dermis. The inflammatory infiltrate was composed of histiocytes, either isolated or forming poorly defined granulomas, and some multinucleated giant cells interspersed with lymphocytes, plasma cells, and neutrophils. No suppurative granulomas were observed. In addition to hematoxylin-eosin staining, other special techniques involving staining with methenamine silver, periodic acid Schiff, Gram, Ziehl-Neelsen and Fite Faraco were used to rule out an infectious etiology (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Based on the results obtained, the lesion was diagnosed as an idiopathic facial aseptic granuloma. No treatment was prescribed.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Four months after the first visit, the lesion had completely disappeared, leaving a slightly pink macule in its place (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.)</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The exact etiology of IFAG is unknown, although Boralevi et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> have postulated that these lesions may be related to a granulomatous process around an embryological remnant or may belong to the spectrum of granulomatous rosacea in infants. A prospective multicenter study of 30 cases by the same authors reported the mean duration of the lesions to be 11 months and found antibiotic treatment ineffective.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The principal differential diagnosis for this type of lesion includes benign tumors (especially pilomatricomas of the eyelids or eyebrows,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> dermoid or epidermoid cysts, and chalazia), pyogenic granulomas, Spitz nevi, and xanthogranulomas. It is also important to rule out the possibility of a bacterial or fungal infection, or infection with mycobacteria or parasites (leishmaniasis), all of which are more common in immunocompromised patients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These lesions can sometimes resemble vascular malformations or hemangiomas, although the clinical course is very different.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Other differential diagnoses include nodulocystic acne presenting few symptoms.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Our aim in presenting this case is to emphasize the importance of considering IFAG in the differential diagnosis of acquired facial nodules in children. It is important to inform parents of the benign course of these lesions. Follow-up until the lesion resolves is recommended.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The characteristic clinical appearance and location of IFAG and the lack of lymphadenopathy or constitutional symptoms may make a direct clinical diagnosis possible and thereby avoid unnecessary interventions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hiraldo-Gamero A, et al. Granuloma aséptico facial idiopático. Actas Dermosifiliogr. 2013;104:635–6.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1188 "Ancho" => 1583 "Tamanyo" => 134921 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Asymptomatic red to violaceous nodule in the upper region of the left cheek.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1200 "Ancho" => 1600 "Tamanyo" => 528293 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Note the presence of a granuloma composed of histiocytes (red arrows). To the right of this is a multinucleated giant cell (black arrow). Note the higher magnification in top right-hand corner of the image. Hematoxylin-eosin ×20.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1200 "Ancho" => 1600 "Tamanyo" => 150981 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The lesion resolved spontaneously leaving a residual pink macule.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A toddler with facial nodules: A case of idiopathic facial aseptic granuloma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.J. Martínez-Díaz" 1 => "J. Kim" 2 => "A. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 18 | 13 | 31 |
| 2024 Octubre | 115 | 64 | 179 |
| 2024 Septiembre | 135 | 35 | 170 |
| 2024 Agosto | 187 | 86 | 273 |
| 2024 Julio | 123 | 55 | 178 |
| 2024 Junio | 128 | 73 | 201 |
| 2024 Mayo | 100 | 48 | 148 |
| 2024 Abril | 144 | 41 | 185 |
| 2024 Marzo | 101 | 50 | 151 |
| 2024 Febrero | 100 | 39 | 139 |
| 2024 Enero | 111 | 42 | 153 |
| 2023 Diciembre | 114 | 24 | 138 |
| 2023 Noviembre | 173 | 36 | 209 |
| 2023 Octubre | 115 | 27 | 142 |
| 2023 Septiembre | 151 | 31 | 182 |
| 2023 Agosto | 103 | 26 | 129 |
| 2023 Julio | 121 | 57 | 178 |
| 2023 Junio | 85 | 31 | 116 |
| 2023 Mayo | 104 | 40 | 144 |
| 2023 Abril | 94 | 31 | 125 |
| 2023 Marzo | 129 | 45 | 174 |
| 2023 Febrero | 96 | 26 | 122 |
| 2023 Enero | 93 | 37 | 130 |
| 2022 Diciembre | 111 | 56 | 167 |
| 2022 Noviembre | 109 | 36 | 145 |
| 2022 Octubre | 96 | 27 | 123 |
| 2022 Septiembre | 71 | 48 | 119 |
| 2022 Agosto | 86 | 53 | 139 |
| 2022 Julio | 123 | 42 | 165 |
| 2022 Junio | 66 | 47 | 113 |
| 2022 Mayo | 71 | 46 | 117 |
| 2022 Abril | 85 | 49 | 134 |
| 2022 Marzo | 65 | 56 | 121 |
| 2022 Febrero | 81 | 32 | 113 |
| 2022 Enero | 90 | 38 | 128 |
| 2021 Diciembre | 74 | 41 | 115 |
| 2021 Noviembre | 87 | 60 | 147 |
| 2021 Octubre | 80 | 62 | 142 |
| 2021 Septiembre | 60 | 42 | 102 |
| 2021 Agosto | 76 | 30 | 106 |
| 2021 Julio | 50 | 28 | 78 |
| 2021 Junio | 94 | 25 | 119 |
| 2021 Mayo | 84 | 57 | 141 |
| 2021 Abril | 317 | 112 | 429 |
| 2021 Marzo | 158 | 44 | 202 |
| 2021 Febrero | 113 | 29 | 142 |
| 2021 Enero | 53 | 28 | 81 |
| 2020 Diciembre | 59 | 28 | 87 |
| 2020 Noviembre | 36 | 30 | 66 |
| 2020 Octubre | 34 | 25 | 59 |
| 2020 Septiembre | 34 | 28 | 62 |
| 2020 Agosto | 26 | 42 | 68 |
| 2020 Julio | 19 | 40 | 59 |
| 2020 Junio | 34 | 49 | 83 |
| 2020 Mayo | 34 | 39 | 73 |
| 2020 Abril | 35 | 61 | 96 |
| 2020 Marzo | 33 | 28 | 61 |
| 2020 Febrero | 3 | 18 | 21 |
| 2020 Enero | 4 | 19 | 23 |
| 2019 Diciembre | 8 | 18 | 26 |
| 2019 Noviembre | 4 | 12 | 16 |
| 2019 Octubre | 0 | 19 | 19 |
| 2019 Septiembre | 5 | 24 | 29 |
| 2019 Agosto | 4 | 16 | 20 |
| 2019 Julio | 4 | 30 | 34 |
| 2019 Junio | 6 | 42 | 48 |
| 2019 Mayo | 6 | 122 | 128 |
| 2019 Abril | 2 | 74 | 76 |
| 2019 Marzo | 4 | 20 | 24 |
| 2019 Febrero | 0 | 7 | 7 |
| 2019 Enero | 5 | 10 | 15 |
| 2018 Diciembre | 2 | 18 | 20 |
| 2018 Noviembre | 2 | 6 | 8 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 6 | 2 | 8 |
| 2018 Agosto | 0 | 11 | 11 |
| 2018 Julio | 0 | 10 | 10 |
| 2018 Junio | 0 | 6 | 6 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Abril | 0 | 3 | 3 |
| 2018 Marzo | 22 | 8 | 30 |
| 2018 Febrero | 64 | 8 | 72 |
| 2018 Enero | 71 | 11 | 82 |
| 2017 Diciembre | 91 | 10 | 101 |
| 2017 Noviembre | 66 | 8 | 74 |
| 2017 Octubre | 84 | 8 | 92 |
| 2017 Septiembre | 40 | 15 | 55 |
| 2017 Agosto | 65 | 15 | 80 |
| 2017 Julio | 60 | 20 | 80 |
| 2017 Junio | 167 | 27 | 194 |
| 2017 Mayo | 65 | 14 | 79 |
| 2017 Abril | 87 | 10 | 97 |
| 2017 Marzo | 46 | 23 | 69 |
| 2017 Febrero | 157 | 14 | 171 |
| 2017 Enero | 94 | 21 | 115 |
| 2016 Diciembre | 96 | 15 | 111 |
| 2016 Noviembre | 170 | 14 | 184 |
| 2016 Octubre | 130 | 24 | 154 |
| 2016 Septiembre | 240 | 14 | 254 |
| 2016 Agosto | 197 | 10 | 207 |
| 2016 Julio | 98 | 13 | 111 |
| 2016 Junio | 10 | 13 | 23 |
| 2016 Mayo | 8 | 16 | 24 |
| 2016 Abril | 4 | 3 | 7 |
| 2016 Marzo | 3 | 1 | 4 |
| 2016 Febrero | 5 | 2 | 7 |
| 2016 Enero | 6 | 2 | 8 |
| 2015 Diciembre | 15 | 3 | 18 |
| 2015 Noviembre | 31 | 2 | 33 |
| 2015 Octubre | 20 | 7 | 27 |
| 2015 Septiembre | 10 | 1 | 11 |
| 2015 Agosto | 5 | 4 | 9 |
| 2015 Julio | 170 | 6 | 176 |
| 2015 Junio | 176 | 10 | 186 |
| 2015 Mayo | 76 | 14 | 90 |
| 2015 Abril | 95 | 6 | 101 |
| 2015 Marzo | 102 | 6 | 108 |
| 2015 Febrero | 91 | 7 | 98 |
| 2015 Enero | 87 | 2 | 89 |
| 2014 Diciembre | 93 | 10 | 103 |
| 2014 Noviembre | 49 | 4 | 53 |
| 2014 Octubre | 84 | 7 | 91 |
| 2014 Septiembre | 83 | 5 | 88 |
| 2014 Agosto | 68 | 2 | 70 |
| 2014 Julio | 86 | 7 | 93 |
| 2014 Junio | 66 | 5 | 71 |
| 2014 Mayo | 75 | 12 | 87 |
| 2014 Abril | 63 | 5 | 68 |
| 2014 Marzo | 104 | 16 | 120 |
| 2014 Febrero | 55 | 7 | 62 |
| 2014 Enero | 54 | 6 | 60 |
| 2013 Diciembre | 57 | 4 | 61 |
| 2013 Noviembre | 33 | 8 | 41 |
| 2013 Octubre | 28 | 7 | 35 |
| 2013 Septiembre | 27 | 7 | 34 |
| 2013 Agosto | 1 | 1 | 2 |
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