Butterfly rash

A 32-year-old married Indian woman on treatment for hypothyroidism presented with a photosensitive rash associated with a burning sensation over the cheeks for the preceding two months. Notably, she also complained of flushing before the present symptoms. Her symptoms aggravated on taking spicy food and alcoholic beverages. The facial rash was not associated with any history of fever, arthralgia, proximal muscle weakness, or other features suggestive of systemic involvement. She denied any history of miscarriage or topical steroid application. An indurated, erythematous, mildly edematous plaque studded with multiple inflammatory papules, tiny telangiectatic vessels, and pustules involving bilateral cheek, chin, and bridge of the nose but sparing the nasolabial folds was observed [Figure 1]. There was no oral ulceration. Other mucocutaneous sites were unaffected. Systemic examinations were within normal limits. Routine laboratory investigations were notable for mildly elevated erythrocyte sedimentation rate (19 mm/h; reference range 0-15 mm/hour). Antinuclear antibody testing was negative. Urinalysis did not reveal any abnormalities.