Mystery Diagnosis: Face Rash
Lorraine is a 32-year-old administrative executive who develops a rash on her face after a summer excursion with her family in Hawaii. Is it a sunburn? Or is it something more serious?
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Lorraine is a 32-year-old business administrator who came to see me for a sunburn she developed on her face after a one week summer excursion with her family in Hawaii. She doesn’t get out much, she tells me, as her career keeps her quite busy indoors. But she’s never had a burn like this before, and she is embarrassed to go back to work “looking like an apple,” she exclaims.
Well, it is summertime. And I know what that means—lots of time spent outdoors for my patients. It’s not an uncommon phenomenon during the hot summer months, especially here in sunny Southern California. My sunburn diagnoses are unfortunately more common than I’d like.
If you’ve read my previous articles you may already be aware that doctors have a very structured evaluation process for each symptom at each visit (hence, why some visits are more time-consuming than you’d imagine). It first begins with the patient history. This initially entails perusing the patient chart for their past medical history and then gathering information about the present history (in this case the facial rash).
Lorraine is a very healthy young woman. She only suffers from adult acne, a very common diagnosis believe it or not, in addition to asthma since childhood. She very infrequently uses an as-needed rescue inhaler for her asthma, in addition to a daily antibiotic called minocycline for her acne.
She tells me that her rash began after sun exposure, while surfing the Hawaiian tides. She used to surf in her 20’s and couldn’t pass up the chance to ride the waves in one of the sport’s most sought-after hot-spots.
She tells me that she did indeed use sunblock, but that she could have made more of an effort to reapply every two hours as she knows she should.
On exam, Lorraine has some mild diffuse “erythema” (doctor lingo for redness) on her chest and upper arms, but the worst sunrays seem to have struck her cheeks and nose. Thankfully, there is no blistering, the skin is dry, yet it is rather pain to the touch.
Given her recent sun exposure, and that she is a rather healthy young patient, sunburn does seem to be the most likely diagnosis. In addition, Lorraine is taking minocycline, which like many other acne treatment, is known to cause “photosensitivity” and increase the risk of sunburn.