(Note: the high hairline and absence of eyebrows are baseline for this patient.)

A 62-year-old female presents to the urgent care center with a three-week history of a pruritic facial rash that initiated on one cheek, then spread to the rest of the face.

The patient states the rash got worse after sun exposure.
Initially, she self-treated with cold cream, Eucerin, and other over-the-counter moisturizers that did not help. Eventually, the patient tried a topical hydrocortisone cream that made the rash much worse.
You note there is no rash anywhere else on the body.

View the photo taken at the time pf presentation, and consider which of the following is the most likely diagnosis:

  1. Discoid lupus
  2. Polymorphic light eruption
  3. Tinea faciei
  4. Contact dermatitis

The correct answer will be revealed on the following page.

Clinical Challenge: September, 2009

Tracey Quail Davidoff, MD

Senior Clinical Instructor at Rochester Regional Health/Immediate Care, Editorial Board Member for the Journal of Urgent Care Medicine
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