28-year-old woman comes to the office due to worsening of a skin rash on her back and arms for the past 2
weeks. She has had no associated pain or pruritus. During her teenage years, the patient had comedonal acne
on her face, which resolved with topical medications. She was diagnosed with systemic lupus erythematosus 2
years ago and is on oral prednisone due to a recent exacerbation with pain and swelling in the small joints of the
hands. The patient also takes hydroxychloroquine and as-needed nonsteroidal anti-inflammatory drugs. She does
not use tobacco, alcohol, or illicit drugs. She works in a dry-cleaning facility. The patient is sexually active with her
boyfriend and has an intrauterine device for contraception. Temperature is 37 C (98.6 F), blood pressure is 130/86
mm Hg, and pulse is 78/min. Skin examination shows uniform-appearing, 1- to 3-mm, erythematous papules
across her back, shoulders, and upper arms. There is mild symmetric synovitis in the hands and wrists, but the
remainder of the physical examination is unremarkable. Which of the following is the most likely cause of this
patient’s skin rash?
- Q A. Acne vulgaris
- Q B. Chlorinated chemical exposure
- Q C. Cutaneous manifestation of systemic lupus erythematosus
- Q D. Disseminated gonococcal infection
- Q E. Herpes simplex virus infection
- Q F. Medication adverse effect
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