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A 31 year-old woman, previously healthy, presented a four-month history of enlarging plaques on the face and back without any constitutional complaints. She referred to one unprotected heterosexual contact but denied any past history of sexually transmitted infections. Physical examination revealed multiple, tumid, nontender erythemato-violaceous, slightly scaly, flattopped plaques, distributed over her forehead [Figure 1], left cheek, right oral commissure and back [Figure 2]. Palms, soles, oral and genital mucosa were all free of lesions. There was no enlargement of lymph nodes, liver or spleen and the remaining physical examination was normal. Routine blood tests revealed an erythrocyte sedimentation rate of 84 mm at the end of one hour. Serological tests were negative for syphilis, hepatitis B and C and human immunodeficiency virus (HIV). Skin biopsy showed hyperkeratosis, focal parakeratosis and irregular acanthosis of the epidermis. There was a dense cellular infiltrate, grossly nodular, in the entire dermis [Figure 3],[Figure 4]. The results of the periodic acid-Schiff, Ziehl-Neelsen and Warthin-Starry stains were all negative. Cell-marker studies showed a heterogeneous population of cells without any phenotypic changes.

Infiltrated plaques on the face and back