A 28-year-old woman sat on the examining table pointing at patches on the sides of her face and scalp where it looked as if miniature grenades had exploded, leaving crevices.
“Can you get rid of them?” she asked.
“How long have these been there?”
“A couple of years. But now they’re getting worse.”
In addition to the lesions, I noticed a red, raised rash that spread across her cheeks, over the bridge of her nose, and around her eyes. I looked over her chart for medications and allergies. None were listed.
“So you don’t take any prescription or other medications?”
“Nope. I just take a whole bunch of aspirin, or whatever I can afford, because my bones ache.”
“Are you stiff when you first get up in the morning? Do your joints swell? How long does it last?”
These questions would narrow the diagnostic possibilities, but a skin biopsy and ...
