A 37-year-old white woman presented with a 1-year history of an intensely pruritic, burning eruption that was limited to her face. She stated that theitching and burning sensation would occur 1 or 2 days before the appearance of erythematous macules and small vesicles on her face. The vesicles wouldquickly rupture and crusts would form. She had been treated for presumed acne, but the use of topical and systemic antibiotics and topical retinoids onlyworsened the burning and erythema. Her medical history was notable for type 1 diabetes mellitus and iron deficiency anemia, which did not improve withoral iron supplementation. Also, a small-bowel biopsy specimen that had been obtained 2 months before presentation revealed mucosal inflammation that wasconsistent with gluten-sensitive enteropathy. The patient denied having current symptoms of diarrhea, bloating, cramping, abdominal discomfort, or other systemiccomplaints. On further questioning, however, she did recall a remote history of a similar eruption on her buttocks, as well as focal areas of pruritusand burning on her shoulders and upper back area.
Kaplan AL, Lee LH, Hall III RP. Localized Facial Macules and Vesicles—Quiz Case. Arch Dermatol. 2004;140(3):353-358. doi:10.1001/archderm.140.3.353-g