Granulosis rubra nasi seen through the dermatoscope

Clinical presentation

A 14-year-old girl presented with 1-year history of multiple asymptomatic 2- to 3-mm skin-colored to erythematous papules over the dorsum of the nose, associated with occasional sweating (Fig 1).

Fig 1.

Clinical image of granulosis rubra nasi. Multiple skin-colored to erythematous papules over the alae (A) and dorsum (B) of the nose.

Dermoscopic appearance

Under polarized contact dermoscopy, there was a diffusely erythematous background with a discrete round-to-oval pink and red structureless areas, a few of them showing overlying scatted to grouped brown dots (Fig 2).

Fig 2.

Dermoscopic image of granulosis rubra nasi. Discrete round-to-oval pink and red structureless areas, a few of them showing overlying scatted to grouped brown dots (arrows).

Histopathologic diagnosis

Histopathology of a papule showed epidermal atrophy, basal vacuolar degeneration, and nodular collection of lymphocytes; few histiocytes; and multiple blood vessels with swollen endothelial cells consistent with a diagnosis of granulosis rubra nasi (Fig 3).

Key message.

Granulosis rubra nasi, a rare benign self-limited disorder of childhood, can rarely persist indefinitely. It can affect children from 6 months to 15 years of age, with peak age being 7 to 12 years. Familial cases have been reported with an autosomal dominant inheritance. Altered vasomotor and secretory function of the nose is postulated to be responsible for the condition, but exact etiopathogeneses are still unknown. The disorder presents with multiple asymptomatic erythematous papules on and around the nose associated with hyperhidrosis. Histology is helpful in difficult-to-diagnose cases and demonstrates vasocentric mononuclear cell infiltrate along with dilated blood and lymphatic vessels. The dermoscopic features described for the clinical differential diagnoses of the index case are papulopustular rosacea (linear vessels arranged in a polygonal network along with follicular pustules), papular sarcoid (reddish-orange background, yellowish-orange globule, scar-like depigmented area, and linear, branching, and arborizing vessels), trichoepithelioma (multiple milia-like cysts, arborizing vessels, and rosettes amidst a whitish background).^1,2 In this case, the pink-to-red globules corresponded to the dermal nodular inflammatory collection with prominent vascularity. Counseling and explaining the self-resolution nature of the condition after puberty is the mainstay of management. Treatments like topical indomethacin, tacrolimus, Botulinum toxin A, cryotherapy, x-ray therapy, oral steroids, and tetracycline have been tried. The presence of discrete round-to-oval pink and red structureless areas and absence of vascular structure may provide a clue to differentiate granulosis rubra nasi from its clinical mimics.

Fig 3.

Histologic image of granulosis rubra nasi. A, Epidermal atrophy, basal vacuolar degeneration, and nodular collection of lymphocytes; few histiocytes; and multiple blood vessels with swollen endothelial cells (Hematoxylin-eosin stain; original magnification: ×50). B, Increased number of blood vessels with swollen endothelial cells (arrow). (A and B, hematoxylin-eosin stain; original magnifications: A, ×50; B, ×400.)