A nurse, age 54 years, arrived for evaluation of what she and her fellow hospital workers presumed to be lupus. The rash had been present for approximately one month. Such systemic symptoms as joint pain, fever and malaise were not reported. The rash burned and itched and had persisted despite the application of a number of OTC creams and ointments. An antinuclear antibody (ANA) test ordered by the patient’s primary-care provider was nonreactive. A complete blood count and comprehensive metabolic profile showed no abnormal results.

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A 26-year-old woman first noticed a facial rash early in the summer but had to wait several weeks before she could be seen in the dermatology clinic. Feeling the need to try something in the meantime, she used OTC moisturizers and 1% hydrocortisone cream to obtain relief from mild itching and burning. Neither of the OTC treatments was helpful, and the rash grew more erythematous. The woman’s symptoms were particularly exacerbated after a day spent in the sun working as a landscaper.

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