TLDR Three Iranian men had reddish-brown facial pigmentation with no effective treatment.
In 1992, three Iranian men aged 15, 18, and 28 presented with increasing pigmentation over their cheeks, extending to the preauricular areas. The pigmentation, which began in childhood, was reddish-brown with a granular texture due to pinhead-sized white follicular papules. Vellus hair growth was affected, but there was no scarring or atrophy. Two patients linked the pigmentation to temperature extremes, and one experienced a burning sensation in sunlight. Despite using sunblocks and topical steroids, there was no improvement. Histopathologic examination of biopsies from two patients showed slight hyperkeratosis, follicular hyperplasia, and intense melanin pigmentation in the basal layer, with mild perivascular mononuclear cell infiltration. The condition was identified as erythromelanosis follicularis faciei et colli.
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