Idiopathic facial aseptic granuloma
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Synopsis
The pathogenesis of IFAG is unknown, and no common predisposing factors including family history or prior trauma have been consistently associated. It has been hypothesized that IFAG may be due to a reactive process around an embryological remnant or may be related to granulomatous rosacea given its association with chalazia.
Codes
ICD10CM:L92.9 – Granulomatous disorder of the skin and subcutaneous tissue, unspecified
SNOMEDCT:
123633001 – Focal granulomatous inflammation
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Benign neoplasms:- Pilomatricoma – Unlike IFAG, pilomatricoma has a positive teeter-totter sign and is firmer in texture.
- Dermoid and epidermoid cysts
- Bacterial pyoderma (abscess, furuncle) – Culture for bacteria in IFAG remains negative except in cases of superinfection, and IFAG is painless in comparison.
- Atypical mycobacterial infection
- Cutaneous leishmaniasis (New World, Old World)
- Fungal (sporotrichosis, blastomycosis, cryptococcosis, coccidioidomycosis)
- Chalazion
- Pyogenic granuloma
- Foreign body granuloma
- Spitz nevus
- Xanthogranuloma
- Nodulocystic infantile acne – Presence of comedones distinguishes this entity from IFAG.
- Granulomatous rosacea
- Hemangiomas or other vascular malformations (see, eg, infantile hemangioma)
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Management Pearls
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Therapy
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References
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Last Reviewed:08/12/2019
Last Updated:08/12/2019
Last Updated:08/12/2019