A 55-Year-Old Woman With Bumps on Her Face

Amin Esfahani, MD; Mary E. Lohman, BA; Anne Laumann, MBChB, MRCP(UK)


October 11, 2017

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 55-year-old African American woman presents with a 6-month history of "bumps" on her cheeks. She reports that the spots initially appeared on both cheeks without any specific precipitating factors. She states that the spots generally last approximately 10 days; however, as they disappear, new ones occur. Associated symptoms include an occasional sensation of warmth and burning in the affected areas, especially after exposure to sunlight. These symptoms are aggravated by heat.

She has treated her face with tea tree oil without relief. She had no previous episodes, prior to 6 months ago, and has no history of eczema or acne. She had not used any new facial products, detergents, or medications prior to onset of the eruption. She also reports no recent travel.

A review of her systems is significant for occasional flushing, which has occurred for approximately 3 years. She states that she has occasional dryness and a "gritty" sensation in her eyes. She reports no fever, recent illness, night sweats, unintentional weight loss, shortness of breath, chest tightness, cough, nausea, vomiting, diarrhea, or dysuria.


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