Histologic examination revealed a basket-weave orthokeratosis overlying a normal epidermis, and there were several poorly formed granulomas containing numerous lymphocytes, neutrophils, histiocytes, and occasional giant cells found mainly within the superficial dermis in a perifollicular distribution.
At the initial visit, our patient was started on a twice-daily regimen of topical 0.75% metronidazole gel. At the follow-up visit 1 month later, the rash had worsened, with new periorbital involvement. Combination therapy with the topical metronidazole and oral doxycycline (100 mg twice a day) was initiated. One week later, the patient reported improvement of the eruption and was asymptomatic.
Papular Facial Eruption in an African American Adolescent—Diagnosis. Arch Dermatol. 2006;142(6):775-780. doi:10.1001/archderm.142.6.775-f