A recent treatment regimen worsened this 13-year-old Native American girl’s “acne.” Within hours of beginning the treatment (application of benzoyl peroxide–containing gel and twice-daily use of a benzoyl peroxide–based cleanser), she reported intense burning and redness in the treated areas. She stopped this regimen after a week, and her primary care provider referred her for evaluation.
The lesions have been on her face since age 2 and are not usually problematic.
The patient has a notable history of atopy, with seasonal allergies and occasional bouts of asthma. She claims to have no other health problems but does admit to being overweight for most of her life; this is an issue for most of her family members, as well. Several of her relatives developed diabetes as adults.
EXAMINATION
The patient is 5 ft tall and weighs 250 lb. She has type IV skin, consistent with her Native American heritage. The posterior aspects of both cheeks are quite red and covered with hyperkeratotic, rough, pinpoint papules. There are no comedones or pustules there or elsewhere on her body.
No other blemishes or lesions are seen on her face, but there are hundreds of hyperkeratotic papules on her bilateral triceps. The skin in all her intertriginous (skin-on-skin) areas is quite dark and has a faintly papular, velvety appearance.
What is the diagnosis?