This 2-year-old girl's mother is upset by the redness of her daughter's cheeks, which are occasionally rough and swollen. The child was similarly affected around the same time last year, beginning in September and lasting until the spring. The changes so alarmed her primary care provider that bloodwork was ordered to (successfully) rule out lupus.

OTC topicals have not helped, nor have changes in diet, soap, and laundry detergent. A course of cephalexin and topical mupirocin were also unsuccessful.

Additional history-taking reveals a strong family history of atopy. The child herself has seasonal allergies and mild asthma.

On examination, both malar cheeks are red, moderately scaly, and slightly swollen. They are not tender to the touch, and no broken skin is detected. No palpable nodes can be felt in the area. The child's skin is dry but appears otherwise normal.