CASE
A 73-year-old woman was referred to dermatology for evaluation of lesions appearing acutely two to three times a year on her right eyelid and five other sites on the trunk. Initially red, then taking on a brown tinge, the lesions would slowly fade and disappear over approximately 6 weeks. The only symptom was slight itching. The pattern had repeated itself for at least 10 years, during which she had been otherwise healthy except for periodic vaginal yeast infections for which she took brief courses of fluconazole.
She denied ever having had a urinary tract infection or any recent history of taking oral antibiotics. She further denied any history of regular or even occasional use of OTC medications, such as pseudoephedrine, acetaminophen, or NSAIDs.
On examination, the medial one-third of the upper right eyelid was covered with a brown red macule, the central portion of which was faintly desquamative (Figure 1). Five similar but more well-defined round macules were seen on the trunk. According to the patient, the lesions were in the same locations as during past episodes. The truncal lesions were targetoid, with concentric circles of light and dark pigment, and averaged about 3 cm in diameter. Punch biopsy of a truncal lesion showed interface dermatitis with vacuolar changes and Civatte bodies (anucleate basal cells incorporated into the inflamed papillary dermis).
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