Lupus profundus

History

          Painless deep dermal and subcutaneous nodules and plaques involving the right cheek of this lady caused unilateral facial atrophy with cup-like depression (sunken cheek) of 12 years duration. At presentation, two new dermal nodules beneath normal skin were found in the lower part of the affected area. These nodules were firm, rubbery and non tender. A deep skin biopsy was taken from one of the new nodules has showed lymphocytic panniculitis with sharply circumscribed lymphocytic nodules in the lower dermis and subcutaneous fat. Serological investigations were normal apart from raised ESR and positive ANF.