A Japanese man in his 80s presented with a 3-year history of erythematous papules on the bilateral cheeks without any additional symptoms. The lesions had repeatedly recurred despite topical steroid therapy. The patient was otherwise healthy. Physical examination revealed papules and plaques ranging up to 1 cm in diameter on the lateral cheeks and behind the ears and neck along with a red-brown hue (Figure, A). Complete blood cell count and comprehensive metabolic panel results were unremarkable. However, serum protein electrophoresis revealed polyclonal hypergammaglobulinemia. Antinuclear antibody and anti-Ro/SS-A and anti-La/SS-B antibodies were undetectable by indirect immunofluorescence or double immunodiffusion methods. Computed tomography (CT) revealed bilateral parotid gland swelling together with mild lymphadenopathy in the mediastinum and hilus. A skin biopsy specimen was obtained from a papule on the neck for further analysis (Figure, B-D).
Tsuji A, Minagawa A, Okuyama R. Erythematous Papules and Plaques on the Cheeks. JAMA Dermatol. 2016;152(5):569-570. doi:10.1001/jamadermatol.2015.5252