A 17-year-old boy was born with rough skin on his face, arms, legs, thighs, and posterior shoulders. Over the years, his face, especially the posterior lateral aspects, has become progressively redder, while the roughness has increased. The redness is amplified with heat, exertion, anger, or embarrassment. Regarding the latter, mere mention of the condition by his siblings results in worsening of the erythema. Additionally, the skin in his eyebrows is now turning red and scaly.
The patient denies a history of dandruff. His parents, who have accompanied him to the clinic, report a family history of similar skin changes on triceps and thighs, but not on faces. There is no family history of cardiac anomalies or other congenital abnormalities. The boy’s health is otherwise excellent.
The patient’s bilateral triceps are covered with fine, rough, follicular papules, which create a faintly erythematous look. Similar lesions are visible on his posterior shoulders and anterior thighs. The skin beneath his eyebrows is faintly erythematous and scaly.
The posterior sides of his face are bright red and covered with the same type of papules. The erythema grows redder as it approaches the immediate preauricular areas, where it ends abruptly, creating a sharp demarcation with the white skin closer to the ears. The visual effect is almost clownish, as if bright red makeup had been applied.
What’s the diagnosis?