A 66-year-old white man presented with a 3-month history of “red open sores” on his face that were not painful or pruritic. He had been seen by his family physician, who prescribed 8 weeks of terbinafine (Lamisil) therapy (250 mg/d), which did not resolve the appearance of the lesions. His medical history included silicosis and pneumococcal pneumonia as well as prostatitis, which had developed 1 month before the appearance of the facial lesions. He had also been exposed to clay dust for 35 years, while working in a clay refinery, and had worked with calves that were reportedly dying of an unspecified fungal infection.
Bradley VR, Patterson CC, Scarborough DA. Verrucous Facial Plaques—Quiz Case. Arch Dermatol. 2006;142(3):385-390. doi:10.1001/archderm.142.3.385-d