A woman in her 40s with a medical history of pulmonary embolism and deep venous thrombosis presented with a 6-month history of pruritic, pink scaling plaques on her face and neck (Figure, A). The lesions subsequently involved her chest, abdomen, and back and flared with sun exposure. A diagnosis of lupus erythematosus (LE) was favored, but the lesions failed to improve on a regimen that included hydroxychloroquine sulfate, fluocinonide ointment, 0.05%, and tacrolimus ointment, 0.1%. Biopsy samples were obtained for histopathologic evaluation.