Eosinophilic angiocentric fibrosis was first described by Holmes and Panje (1) in 1983 as "intranasal granuloma faciale" because of the histologic appearance of concentric fibrosis surrounding small-caliber arterioles, with numerous eosinophils scattered throughout the lesion.
(4) Rarely, EAF may present with a prior or concurrent history of granuloma faciale. (10) There is a clear absence, however, of systemic diseases such as granulomatosis with polyangiitis, Churg-Strauss syndrome, sarcoidosis, Sjogren syndrome, and infectious granulomatosis.
The differential diagnosis includes subacute cutaneous lupus, lichen planus, seborrheic dermatitis, Jessner's lymphocytic infiltrate, polymorphous light eruption, rosacea, granuloma faciale
, and sarcoidosis.
Eosinophilic Angiocentric Fibrosis (EAF) had been described as rare submucosal fibrosing vasculitis, believed by some to be the mucosal counterpart of granuloma faciale .
EAF shares similar histological features to granuloma faciale of the skin and sometimes can occur concurrently in association with this benign skin condition, as reported by Nogueira et al.
Differential diagnoses of ALHE include granuloma faciale
, persistent insect bite reaction, injection site granuloma, cutaneous lymphoma, cavernous hemangioma, pyogenic granuloma, angiomatous lymphoid hamartoma, pseudolymphoma (lymphocytic infiltrate of Jessner, lymphocytoma cutis), sarcoidosis and bacillary angiomatosis.
CLFV, which has been reported in the eyelid, is a unique variant of small vessel vasculitis that shows patterned and/or angiocentric fibrosis and is found in localized vasculitis syndromes like granuloma faciale
and some cutaneous inflammatory pseudotumors as well as in systemic vasculitic syndromes like erythema elevatum diutinum and WG [11,34,35].
The differential diagnosis of DLE is extensive and includes actinic keratosis, dermatomyositis, granuloma annulare, granuloma faciale
, keratoacanthoma, lichen planus, subacute cutaneous lupus erythematosus, psoriasis, rosacea, sarcoidosis, squamous cell carcinoma, syphilis, and nongenital warts.
In addition, granuloma faciale
and inflammatory pseudotumor could be excluded from the differential diagnosis because these diseases are not characterized by intense fibrosis and onionskin angiocentric whorling.
Eighteen patients (18%) had nodular and diffuse dermatitis divided as follows: 10 of the 18 (56%) were consistent with foreign body granulomatous reaction; 3 (17%), lymphoid hyperplasia; 2 (11%), granuloma faciale
; 1 (6%), sarcoidosis; 1 (6%), orofacial granulomatosis; and 1 (6%), Sweet syndrome.
A diagnosis of granuloma faciale
was made and the patient was put on intralesional steroid therapy.