Question - Mary is a 35 year-old female who presents to the office for evaluation of a rash on her face. She works as a technology specialist for a local hospital. She denies new soaps, detergents, lotions, environmental exposures, medication, or foods. She doesn't smoke, does have 1 glass of wine almost every evening with dinner. "I have a rash". She states she first noticed the rash one week ago after spending a weekend hiking and camping in Yosemite. She also has noticed some increased tiredness in the last month. The rash is across her face and the bridge of her nose. She had a tonsillectomy at age 15 for chronic strep throat infections. Her father is age 63 with a history of high blood pressure. Her mother is age 62 and has rheumatoid arthritis. The lesions are mildly itchy and uncomfortable. She has had some increased muscle aches and pains which are worse in her hands and wrist. Her mother was adopted and she did not know her biological parents. Her paternal grandfather died of a stroke at age 66. Her paternal grandmother died at age 88 as a result of Alzheimer's disease. Mary has been in a monogamous relationship with her boyfriend for the past 2 years. She tried some aloe on the rash which did not help. She has been otherwise healthy. She has noticed that the rash is worse when she is in the sun.
Identify 3 differential diagnoses based on the information in the case study.