A 21-year-old woman with no significant medical history presented with a 2-year history of asymptomatic, facial redness that flared in sunlight. She had been previously treated with doxycycline, 100 mg/d, and topical sulfacetamide with no effect. On examination, on the cheeks and nasal bridge there were multiple erythematous, annular plaques with focal areas of atrophy. Her medications included only an oral birth control pill. Serum chemical analyses and complete blood cell count showed no abnormalities, and anti-Ro, anti-La, and qualitative ANA antibodies were negative. A clinical diagnosis was made, and over the next 9 months, treatments with minocycline, desonide, topical metronidazole, 0.75%, cream and azelaic acid, 15%, were unsuccessful, and the plaques developed more scarring and atrophy (Figure, A). In addition, the patient began to develop a burning sensation in these areas. A punch biopsy specimen was obtained and submitted for histopathologic review (Figure, B and C).
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