Dermatology: Practical and Conceptual


Research Letter | Dermatol Pract Concept. 2022;12(2):e2022092 1

Solitary Nodular Lesion on the Face in a 9-year-old Boy 
Mohamed Ben Rejeb1, Haifa Mkhinini1, Badreddine Sriha1, Mohamed Denguezli1

1 Dermatology Department, Anatomopathology Department, Hached University Hospital of Sousse, Sousse-Tunisa

Citation: Rejeb MB, Mkhinini H, Sriha B, Denguezli M. Solitary nodular lesion on the face in a 9-year-old boy.  
Dermatol Pract Concept. 2022;12(2):e2022092. DOI: https://doi.org/10.5826/dpc.1202a92

Accepted: October 3, 2021; Published: April 2022

Copyright: ©2022 Rejeb et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Ben Rejeb Mohamed, Dermatology Department, Hached University Hospital of Sousse-Tunisia.  
E-mail: med.benrejeb@gmail.com

Case Presentation 

A 9-year-old boy presented with a 4-month history of 

chronic nodular lesion on the cheek resistant to antibiot-

ics. Dermatological examination showed a 15-mm, solitary, 

firm erythematous nodule on his right cheek (Figure 1a). A 

punch biopsy specimen revealed a dermal chronic inflam-

matory, granulomatous perifollicularinfiltrate consisting 

of histiocytes, neutrophils, and giant cells without necrosis 

(Figure 1: b, c). Based on these findings,we diagnosed the 

case as idiopathic facial aseptic granuloma (IFAG).

Teaching Point

IFAG is a rare, benignpediatric entity characterized by 

chronic, painless erythematous-violaceous nodular lesions 

frequently located on cheeks and eyelids with no predispos-

ing factor [1]. Although pathogenesis remains unclear, the 

disease is thought to be associated with granulomatous ro-

sacea in childhood [1]. Histologically, IFAG lesion is char-

acterized by a dermal chronic inflammation of histiocytic 

granuloma with giant cells, and abscesses without necrosis. 

In general, IFAG tends to resolve spontaneously in less than 

a year. Antibiotics, such as doxycycline and metronidazole, 

could be used to accelerate the involution of IFAG [2].



2 Research Letter | Dermatol Pract Concept. 2022;12(2):e2022092

References

1. Satta R, Montesu MA, Biondi G, Lissia A. Idiopathic facial asep-

tic granuloma: case report and literature review. Int J Derma-

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27259697.

2. Hasbún Z C, Ogueta C I, Dossi C T, Wortsman X. Idiopathic 

Facial Aseptic Granuloma: Updated Review of Diagnostic 

and Therapeutic Difficulties. ActasDermosifiliogr (Engl Ed). 

2019;110(8):637-641. DOI: 10.1016/j.ad.2019.01.005. PMID: 

30819406.

Figure 1. (A): Solitary, Firm, nodular, erythematous lesion on the right cheek, chronic granulomatous inflam-

matory infiltrate in the dermis (B, HE*40) composed of histiocytes, lymphocytes, neutrophils and giant cells 

without necrosis (C, HE*200).