Non-Healing Nasolabial Ulcerated Plaque: A Clinicopathologic Challenge

A 66-year-old male with a history of chronic epistaxis and sinusitis presented with a non-healing ulcer on the right nasolabial region persisting for 7 months. While denying additional symptoms, he admitted to recreational cocaine smoking. Examination revealed an ulcerated plaque with raised, pink-edged borders extending from the right nasal rim to the upper lip. A thorough diagnostic workup was unremarkable, although wound cultures identified growth of Pseudomonas aeruginosa and Staphylococcus aureus. Despite a year-long trial of antibiotics, the ulcer remained resistant to treatment. Biopsy findings included pseudoepitheliomatous hyperplasia with a dense dermal plasmocytic infiltrate and scattered eosinophils. A 6-week course of oral steroids achieved rapid and significant clinical improvement, though the lesion recurred following steroid tapering below 5 mg daily.