A woman with a disfiguring elephantine nose

A Yemeni woman in her fifties presented with a 2-year history of progressive disfiguring enlargement of the nose with fleshy lesions on the margin of the nose and the lips. Similar lesions developed slowly on the eyelids and proximal thighs. Clinical examination showed multiple, asymptomatic, smooth, lobulated and indurated violaceous papules and nodules on the nasal alae.