酒渣鼻双语病例患者，女，55岁，

A55-Year-OldWomanWithBumpsonHerFace患者，女，55岁，面部有肿块Background背景A55-year-oldAfricanAmericanwomanpresentswitha6-monthhistoryof"bumps"onhercheeks.Shereportsthatthespotsinitiallyappearedonbothcheekswithoutanyspecificprecipitatingfactors.Shestatesthatthespotsgenerallylastapproximately10days;however,astheydisappear,newonesoccur.Associatedsymptomsincludeanoccasionalsensationofwarmthandburningintheaffectedareas,especiallyafterexposuretosunlight,whichareaggravatedbyheat.患者，女，55岁，美籍非洲人。脸颊出现肿块，持续6个月。患者称开始时斑点出现在双颊，无具体的诱发因素。患者陈述斑点症状持续10天后消失，又出现了新的斑点。相关症状包括感染部位偶有温觉和灼热感，尤其是日光曝晒过后，受热后症状加重。Shehastreatedherfacewithteatreeoilwithoutrelief.Shehashadnopreviousepisodesandhasnohistoryofeczemaoracne.Shehadnotusedanynewfacialproducts,detergents,ormedicationspriortoonsetoftheeruption.Shealsoreportsnorecenttravel.患者曾使用茶树油治疗，症状未缓解。之前未发作过上述症状，无湿疹或者痤疮病史。患者没有用过新的面部产品，洗涤剂或者药物。近来没有旅行。Areviewofhersystemsissignificantforoccasionalflushing,whichhasoccurredforapproximately3years.Shestatesthatshehasoccasionaldrynessanda"gritty"sensationinhereyes.Shereportsnofever,recentillness,nightsweats,unintentionalweightloss,shortnessofbreath,chesttightness,cough,nausea,vomiting,diarrhea,ordysuria.系统检查发现偶有脸红症状，持续近3年。患者陈述眼睛偶尔干燥，有“沙子”的感觉。自称没有发烧，近来未出现疾病，夜间发汗，无意的体重减轻，呼吸短促，胸闷，咳嗽，恶心，呕吐，腹泻，或排尿困难。PhysicalExaminationandWorkup体检和病情检查Onexamination,thepatient,whohasFitzpatrickskinphototype5,appearswell.Relevantskinfindingsincludemultipledome-shapederythematoustoviolaceouspapules(2–4mm)andafewsuperficialpustulesonabackgroundoffainterythemaonbothcheeks(Figures1and2).Alsopresentarescatteredhyperpigmentedmacules.患者的皮肤的Fitzpatrick分型为V型，体检时看起来良好。相关的皮肤检查发现多个圆顶形红斑紫红色丘疹（2-4mm），双颊有浅脓疱，下有淡淡的红斑（图1和图2），还有分散的色素沉着斑。图1：

图2：

Examinationoftheback,chest,neck,upperextremities,andfingernailsrevealsnoabnormalities.背部，胸部，颈部，上肢和指甲检查没有发现异常。Recent







































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