Acneiform skin disorders Quiz: Ace Your Exams

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A 41-year-old woman presents to the office because of a facial rash she has had for nine months. She reports that it waxes and wanes but never entirely resolves. She also reports a tingling and burning sensation over the affected area when she goes out in her garden during the day. She states that her friend noticed that the flushing increased when they had a glass of wine last night. The rash did not improve with the application of high-potency sunblock or other over-the-counter emollients. The patient does not have any muscle weakness or joint pain. Past medical history is noncontributory. Vitals are within normal limits. Physical examination findings of her face are shown below. Which of the following is the most likely diagnosis in this patient?

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