Persistent crusted yellow–red facial papules

A 35-year-old man gave a one-year history of numerous asymptomatic, persistent, crusted papules (1 to 3 mm diameter) that were concentrated over his central face. The papules were particularly localised to the periorbital region (Figure 1) but were also evident on his chin and his axillae. There was no history of facial flushing, and on examination there were no evident comedones. Skin biopsy showed sarcoidal granulomas with large central areas of caseation necrosis as well as perivascular lymphocytic inflammation (Figure 2).