Six months later, Mr. Rossi presents to his family doctor with an erythematous rash localized to his nose and cheeks. He describes that the rash comes and goes, and that he has a mild burning/stinging sensation on the affected areas. He reports that alcohol, coffee, and sun exposure make the rash worse. He has not changed his skin care regime recently, nor has he had any facial treatments done. He also denied any recent new medications. He is very self-aware of the facial rash. He mentioned multiple co-workers have commented on the rash and he is quite distressed. His review of systems is non-contributory. On examination, you see:
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