P042 A clinicodermoscopic–pathological study of granulomatous facial lesions and clinical mimics in patients with skin of colour

Abstract Granulomatous skin lesions often pose a diagnostic challenge. Our aim was to describe facial granulomatous lesions and their clinical mimics in Indian patients. Patients with clinically suspected granulomatous facial lesions were included. Clinical, histological and dermoscopic features were recorded. Dermoscopic features of granulomatous lesions and mimics were compared. Of the 77 cases included, confirmed diagnosis could be reached for 58 (75%) cases and probable for 12 (16%) cases, while seven (9%) remained unclassified. Of the 70 confirmed or probable cases, 60 (86%) were classified as granulomatous and 10 (14%) as nongranulomatous. The profile of granulomatous disease was orofacial granulomatosis (n = 25), leprosy (n = 15), sarcoidosis (n = 10), two cases each of histoplasmosis and lupus miliaris disseminatus faciei, and one case each of phaeohyphomycosis, cutaneous leishmaniasis, atypical mycobacterial infection, Wegener granulomatosis, periorificial granulomatous dermatitis, and lupus vulgaris. Nongranulomatous lesions included pseudolymphoma (n = 4), lupus erythematosus (n = 4), neutrophilic dermatosis (n = 1) and local reaction to metal implant (n = 1). Histopathology was consistent with the clinical diagnosis in 59 (77%) lesions, discordant in 7 (9%) and nonspecific in 11 (14%). Of the 19 (25%) cases where clinicopathological correlation could not be established, trialling therapeutic regimens clinched the diagnosis in 12 cases. The dermoscopic features of granulomatous facial skin lesions included red background (32%), orange structureless area (37%), vessels (67%), white scales (75%) and white lines (22%). Nongranulomatous lesions showed linear curved vessels (90% vs. 45%, P = 0.009), perifollicular white colour (40% vs. 10%, P = 0.03) and red focal structureless areas (30% vs. 5%, P = 0.03) more frequently than granulomatous lesions. No statistically significant differences (P > 0.05) were noted in other dermoscopic parameters. In conclusion, idiopathic orofacial granulomatosis, leprosy and sarcoidosis are common facial granulomatous skin lesions, and their clinical mimics include pseudolymphoma and lupus erythematosus. Dermoscopic features overlap between granulomatous and nongranulomatous lesions, with some differences.