Pterygium with granuloma faciale-like histologic picture

Description of a case with an atypical conjunctival pterygium with an unusual histologic picture suggesting granuloma faciale, a vasculitis-like disease of facial skin with a chronic, indolent course. Discussion of diagnosis and treatment.

Repeated clinical and histologic observations.

A pterygium with an unusual nasosuperior localization was excised and examined microscopically. There was a dense vessel-related inflammatory infiltrate, essentially identical to granuloma faciale. The lesion recurred and, as granuloma faciale is amenable to dapsone (diphenyl sulfone), treatment with 100 mg daily resulted in rapid improvement, whereas reduction of the dose to 50 mg daily resulted in relapse. Reinstitution of the original dose resulted in normalization of the histologic picture. However, a recurrent pterygium developed, which had a quite unspecific histologic picture.

A disease with a histologic picture essentially identical to granuloma faciale may manifest itself as a pterygium. Treatment with dapsone may be beneficial.