E. L. is a 9-year-old female who presents to your office about a rash noted on her face. It was first noticed about two

E. L. is a 9-year-old female who presents to your office about a rash noted on her face. It was first noticed about two months ago, but seems to wax and wane in severity, and often is not noticeable. Her parents aren’t too concerned about it, but thought since it just never went away, they would get it checked out. It is not pruritic or painful. It is across both facial cheeks and seems dry. They have tried some Eucerin cream and OTC hydrocortisone cream, but it really hasn’t made much of a difference. It may seem more prominent when she is warm, such as after physical activity. E. L. has otherwise been feeling fine. She has had no fever, sweats, chills, unexplained weight gain, or weight loss. Remembers having one headache in her lifetime about 3 months ago. Denies lightheadedness or syncope. Denies sore throat or cold symptoms. Denies chest pain, SOB, cough, or swelling of the extremities. Denies myalgias or arthralgias. Denies history of allergies. Has not taken any medication in the last 8 years. She has no chronic medical conditions or surgeries. No contributing family history. She is up to date on all vaccines. Skin is warm