Xanthomatous infiltrate of the face

We report 2 cases which shared an unusual histopathologic pattern of a xanthomatous infiltrate occurring on the nose. Both patients were women in their fifth decade. Each presented to the dermatology clinic with multiple soft, flesh-colored papules, up to 1 cm, in diameter on the lateral aspects of the nose. The lesions had been present for several years. Both patients were otherwise completely well, and asymptomatic. In one case, focal telangiectasia and central umbilication was noted, and the clinical differential diagnoses included basal cell carcinomas and appendageal tumors. In each case, a biopsy was performed. The lesions appeared histologically quite similar. The epidermis was unremarkable. Within the dermis, there was a mid-reticular dermal infiltrate of macrophages with unilocular and multilocular fat laden cytoplasm, and scalloped nuclei. Only a scant inflammatory infiltrate of lymphocytes and histiocytes was present. Minimal dermal fibrosis was also present. We believe that xanthomatous infiltrate of the face is a distinct clinical entity which presents as multiple flesh-colored papules on the nose, which have a characteristic histologic appearance of abundant lipid-laden macrophages within the dermis.