The Mystery Plaque: Unraveling a Singular Perioral Granulomatous Enigma

A 34-year-old lactating woman presented with erythematous indurated plaques around the perioral region, extending to the nose and forehead, mimicking granulomatous dermatoses. Dermoscopy showed follicular plugging and dermal inflammation. Histopathology revealed epithelioid cell granulomas with giant cells and nerve infiltration, confirming borderline tuberculoid leprosy. The patient was treated with multidrug therapy and closely monitored for reactions. This case underscores the diagnostic challenge of Hansen's disease with atypical centrofacial presentation and emphasizes the importance of histopathological confirmation for timely treatment, particularly in vulnerable groups such as lactating mothers.