A chronic nonresponsive facial eruption

Abstract

A 67-year-old woman presented for evaluation of a waxing and waning facial eruption, which had been present for several years. Of note, the patient denied any prior use of topical steroids. The patient took omeprazole daily for years but denied any correlation with her cutaneous eruption. Physical examination revealed erythematous atrophic plaques and thin plaques with scale on the bilateral cheeks within a diffuse background of telangiectasia (Fig 1 ½F1 ). Dermoscopic evaluation did not reveal follicular plugging. Prior laboratory evaluation by her primary care physician demonstrated absence of antinuclear antibodies and anti-dsDNA antibodies, and low levels of C3 and C4 Q6. A punch biopsy revealed cell-poor interface dermatitis with scattered apoptotic keratinocytes, along with superficial perivascular and perifollicular lymphoplasmacytic infiltrate (Fig 2 ½F2 ).