High-altitude pulmonary edema (HAPE) is a life-threatening form of non-cardiogenic pulmonary edema that occurs in otherwise healthy people at altitudes typically above 2,500 meters (8,200 ft). However, cases have also been reported between 1,500–2,500 metres or 4,900–8,200 feet in more vulnerable subjects. Classically, HAPE occurs in persons normally living at low altitude who travel to an altitude above 2,500 meters (8,200 feet). Re-entry HAPE is also an entity that has been described in persons who normally live at high altitude but who develop pulmonary edema after returning from a stay at low altitude. It is severe presentation of altitude sickness. There are many factors that can make a person more susceptible to developing HAPE, including genetic factors, but detailed understanding is lacking and currently under investigation. HAPE remains the major cause of death related to high-altitude exposure, with a high mortality rate in the absence of adequate emergency treatment. Signs and symptoms
Physiological and symptomatic changes often vary according to the altitude involved.The Lake Louise Consensus Definition for high-altitude pulmonary edema has set widely used criteria for defining HAPE symptoms.In the presence of a recent gain in altitude, the presence of the following:
Symptoms: at least two of:

Shortness of breath at rest
Cough
Weakness or decreased exercise performance
Chest tightness or congestionSigns: at least two of:

Crackles or wheezing (while breathing) in at least one lung field
Central blue skin color
Tachypnea (rapid breathing)
Tachycardia (rapid heart rate)Acute mountain sickness and high altitude cerebral edema may also be present in conjunction with HAPE, however these symptoms may be subtle or not present at all.
Granuloma faciale  is an uncommon benign chronic skin disease of unknown origin characterized by single or multiple cutaneous nodules, usually occurring over the face. : 836  Occasionally, extrafacial involvement is noted, most often on sun-exposed areas. Diagnosis
Skin biopsy for histopathology: 
Focal LCV, diffuse dermal neutrophilia with leukocytoclasia, tissue eosinophilia & perivascular fibrosis. Differential diagnosis
The disease mimics many other dermatoses and can be confused with conditions, such as sarcoidosis, discoid lupus erythematosus, mycosis fungoides, and fixed drug eruption. Treatment
Topical corticosteroid,
Intralesional corticosteroid,
Dapsone,
Colchicine,
Antimalarial,
Pulse dye laser,
Carbon dioxide laser. History
GF was first described in 1945 by John Edwin Mackonochie Wigley (1892–1962). See also
Cutaneous small-vessel vasculitis
List of cutaneous conditions

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