Pustular red plaque on the nose

Abstract

This case report describes a 64-year-old woman presenting with a chronic, erythematous pustular plaque on the nose, unresponsive to rosacea treatments. Dermoscopy revealed a reddish background with orange areas, serpiginous vessels, white parallel lines, pustules, and follicular plugs. Skin biopsy demonstrated granulomatous inflammation with epithelioid and multinucleated giant cells, suggestive of cutaneous tuberculosis, specifically Lupus vulgaris. Differential diagnoses included granulomatous rosacea, sarcoidosis, leishmaniasis, and tuberculoid leprosy. The diagnosis was confirmed based on histopathology and clinical features. The case highlights the importance of dermoscopy and biopsy in diagnosing Lupus vulgaris, which typically exhibits chronic facial involvement with scarring. Prompt recognition allows for effective antituberculous therapy, underscoring the significance of considering tuberculosis in persistent granulomatous skin lesions.