ABSTRACT
A 51-year-old woman presents to the dermatology clinic with a pruritic rash on her face and upper chest, present for 9 months. She reports that the rash is particularly prominent in the summer months when exposed to the sun and she has tried multiple treatments including sunscreen and topical steroids. She has also undergone patch testing and removed potential allergens from her daily cleansers, moisturizers and cosmetic products. She complains of general fatigue and weakness in her arms and legs. She has a medical history significant for hypertension, hyperlipidemia and early-onset arthritis. On examination, there is erythema and edema of the central face and eyelids (24a) and on the hands, there are telangiectasias on the nail folds (24b).
