Bilateral indurated violaceous non-tender plaques on the nasal ala

A 77-year-old Iranian man was visited at the Dermatology Department of Loghman-e Hakim Hospital affiliated with Shahid Beheshti University of Medical Sciences on June 2012 with bilateral, symmetric, raised, violaceous and painless plaques on the nose (both ala nasi), from one year ago. The lesions were small at first and then grew gradually larger in size. Systemic symptoms such as fever, weight loss and night sweat were absent. He had no history of systemic disease, bite, trauma, vaccination, or medication. Past medical history was negative except for cataract in several years ago and he was in good health. He had a history of treatment with oral antibiotics without any improvement. Physical examination revealed bilateral, symmetric, indurated, violaceous, non-tender plaques on the nose (both ala nasi) with some scales and follicular accentuation without discharge (Figure 1). Other examinations were normal and laboratory tests revealed no abnormality. A skin biopsy was performed.