CASE


A 31-year-old woman was referred to dermatology for evaluation of a facial eruption that had persisted for more than 6 months. Her previous treatments included topical antifungal and antibiotic creams, and, most recently, topical mometasone cream (Elocon) twice a day for the past several months. Friends had suggested that she discontinue the corticosteroid cream, but when she tried, the area would begin to burn and tingle until she reapplied the medicine.


The eruption, which burned slightly but did not itch, started in the perinasal areas but had spread down to its present distribution around the mouth. Early on, the patient had changed makeup and other facial products several times, to no good effect. Once during the preceding 6 months, she had taken amoxicillin 500 mg 3 times a day for 7 days for strep throat, which seemed to improve the facial condition for a while. The patient denied any personal or family history of skin disease and was otherwise reasonably healthy. She denied any tendency to flush or blush. Examination revealed a sparse papulopustular eruption con­fined to the perinasal and bilateral upper nasolabial folds, distinctly sparing the rest of the face (Figure 1). Along the periphery of the process were faintly eczematous scaly patches.


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