Modified Mohs micrographic surgery with rim and deep margin technique

Abstract

mis and a Grenz zone that separates the infiltrate from the epidermis and pilosebaceous units. Several treatment modalities have been attempted with variable success rates: topical, systemic, and intralesional corticosteroids, cryotherapy, pulsed dye laser, PUVA, dapsone, antimalarials, and surgical excision. In recent years, success with topical calcineurin inhibitors has been reported, with variable treatment regimens. The pathogenesis of GF is uncertain, but it has been suggested that the process may be an IFN-gamma mediated disease. Accordingly, by blocking T-cell activation and proliferation, as well as the production and release of several proinflammatory cytokines including IFN-gamma, tacrolimus may be useful in the management of this condition. Our patient experienced a drastic improvement within 3 months of treatment with tacrolimus 0.1% ointment, after no response with corticosteroids. In line with previous reports, our case suggests topical tacrolimus may be an efficacious and well-tolerated therapy for GF.