Infiltrative Erythemas and Nodules on a Unilateral Cheek Following Inappropriate Use of a Topical Steroid

A 50-year-old Japanese woman referred to us with erythematous nodules on her left cheek. She had been treated with topical corticosteroids on her left cheek at a previous local clinic for 4 years. A skin biopsy specimen from a nodule showed perifolliculitis and folliculitis with a destruction of hair follicle without epidermal involvement. Based on the patient’s history of the long-term topical corticosteroids and physical examination, we finally diagnosed this case as unilateral steroid-induced rosacea-like dermatitis (SIRD). She stopped topical steroid and was treated with topical application of benzoyl peroxide. One and a half year after starting the treatment, the nodules were flattened. Use of long-term and only unilateral application of topical corticosteroids probably resulted in unique clinical findings in our case. Given the broad clinical differential diagnosis, our case highlights the importance of appropriate application of topical steroids as well as histopathological analysis on any facial erythematous nodules.