Facial superficial granulomatous pyoderma

Dear Editors, We describe the case of a 16-year-old woman who developed ulcerative lesions on the face and in the genital area. She presented with a 5-month history of ulcerative indolent lesions in both zygomatic regions that were sharply demarcated from normal skin. The patient developed new lesions beginning as pustules and then progressing to superficial ulceration with a relatively clean wound bed and vegetative borders. Surrounding skin was erythematous and violaceous. Pustules were also located on the chin area and cheeks (Figure 1A,B). Similar lesions developed in the genital area (Figure 1C). The patient had generally been in good health and she had no history of acne vulgaris. Laboratory test results, including autoimmunity, were in the normal range. No clinical and instrumental evidences of malignancy or inflammatory bowel disease were detected. A culture swab from the ulcerative lesions did not reveal bacterial or fungal infections. Skin biopsy of a lesion in the genital area showed a dense inflammatory infiltrate with neutrophils, lymphocytes, histiocytes, giant cells, focal granuloma formation and granulation tissue. No histological signs of mycobacterium and fungal infections were detected. The diagnosis of superficial granulomatous pyoderma (SGP) was subsequently supported by the clinical and histopathological characteristics.