Cutaneous silica granuloma in a child

A 12-year-old girl had a 4-year history of two asymptomatic, sharply demarcated, granulomatous lesions on her face. The lesions did not respond to topical steroids and histopathologic examination of biopsy specimens showed granulomatous inflammation. Since cutaneous leishmaniasis is endemic where the patient lived, she was diagnosed as chronic cutaneous leishmaniasis but did not respond to meglumine antimoniate treatment. Reexamination of the biopsy specimens under polarized light revealed numerous birefringent crystalline particles, and cutaneous silica granuloma was the final diagnosis. The lesions were treated with intralesional triamcinolone acetonide and completely disappeared. We report this case of cutaneous silica granuloma, which is unusual in children, and emphasize the importance of polarized light microscopic examination of granulomatous skin diseases.