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[Granulomatous periocular eruption].

M Moncourier1, P Pralong1, N Pinel2

  • 1Clinique universitaire de dermatologie, allergologie et photobiologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France.

Annales De Dermatologie Et De Venereologie
|April 16, 2017
PubMed
Summary
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This case study describes atypical facial dermatitis with a sarcoidosis-like appearance in a patient treated for atopic dermatitis. Successful treatment involved discontinuing topical tacrolimus and using hydroxychloroquine.

Area of Science:

  • Dermatology
  • Pathology
  • Immunology

Background:

  • A case of atypical periorificial dermatitis is presented in a patient with a history of atopic dermatitis.
  • The rash exhibited a unique periocular predominance without perioral involvement, presenting with a clinical and histological picture suggestive of sarcoidosis.

Observation:

  • A 33-year-old male with facial atopic dermatitis, poorly responsive to topical corticosteroids, was treated with topical tacrolimus 0.1%.
  • After prolonged tacrolimus use, symmetric erythematous, micropapular lesions with edema developed on the eyelids and periorbital regions.
  • Histopathology revealed epithelioid granulomatous inflammation with sarcoidal giant-cell features, but staging tests for systemic sarcoidosis were negative.

Findings:

  • The patient was diagnosed with granulomatous periorificial dermatitis, despite the rare exclusively periorbital involvement.
Keywords:
Dermatite périorbitaireDermatite périorificielleDermatose facialeEyelidsFacial dermatosisGranulome sarcoïdosiquePaupièresPeriorbital dermatitisPeriorificial dermatitisSarcoid granuloma

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  • Alternative diagnoses considered included pure cutaneous sarcoidosis and tacrolimus-induced granulomatous rosacea, but these were less consistent with the clinical and histological findings.
  • Complete remission was achieved within two months by discontinuing topical tacrolimus and initiating hydroxychloroquine 400mg daily.

    • Implications:

    • This case highlights that a histological sarcoidosis-like appearance on skin biopsy can be associated with perioral dermatitis.
    • The findings suggest a potential link between topical calcineurin inhibitors like tacrolimus and the development of granulomatous facial dermatoses.
    • Successful management with hydroxychloroquine offers a therapeutic option for similar challenging cases.