Infiltrative Erythemas and Nodules on a Unilateral Cheek Following Inappropriate Use of a Topical Steroid

A 50-year-old Japanese woman developed erythematous nodules on her left cheek after using topical corticosteroids for 4 years. A skin biopsy revealed perifolliculitis and folliculitis with hair follicle destruction, but no epidermal involvement. The diagnosis was unilateral steroid-induced rosacea-like dermatitis (SIRD). After stopping the steroid and starting treatment with benzoyl peroxide, the nodules flattened after 1.5 years. The case underscores the importance of appropriate use of topical steroids and histopathological analysis for facial erythematous nodules. The unique clinical findings were likely due to long-term and unilateral application of the steroids.