This 39-year-old man from India has had an itchy eruption on his face for a few months. He is otherwise healthy, takes no medications, and has no other rashes.
A skin biopsy was performed, and the findings were interpreted as consistent with seborrheic dermatitis. Desonide cream and ketoconazole cream were prescribed. When the patient returned 2 months later, there was no improvement.
A second skin biopsy, (this time a 2-mm punch) revealed changes supportive of cutaneous lupus erythematosus, B. Treatment was started with hydroxychloroquine and a mid-potent topical corticosteroid. The patient was told to limit sun exposure and to use sunscreen with a high SPF.