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Leiomyomas are benign soft tissue neoplasms that arise from muscles. Skin is the second most common location for leiomyoma and often localized on the trunk or extremities. Less than 1% of leiomyomas happen in the head and neck. Here we report a case of pilar leiomyoma which located on the face and neck in the form of multiple, large papulonodules plaque. The treatment by excision and grafting would be difficult because of the large surface area involved the patient was treated with nifedipine. We recommend that leiomyomas must be included in the clinical differential diagnosis of painful papulonodules.