Kim, aged 40 years, is of Southeast Asian origin and presents with dark brown patches on her face of more than six months’ duration without pruritus. Kim is a mother of three, whose youngest child is aged five years. She is a non-smoker and does not drink alcohol. On examination, Kim is systemically well. Slightly darkish-brown hyperpigmented macules and patches are evident on her face, involving the bilateral cheeks, forehead with glabella, mandible and chin.

Malcolm, aged 59 years, is concerned about his red face and attends your clinic with his wife. Malcolm is a cattle farmer and though active and relatively fit, he is concerned he may be experiencing blood pressure issues (his father had a touch). His main reason for this self-diagnosis is his continuously flushed and red face. He does not drink. He explains that his face seems to fare better in the winter, when he experiences less irritation. He offers that he is not fond of wind as he finds it causes his skin to pain. He notes that attempts to use his wife’s face creams only seem to make his skin more painful and that sunscreen is the worst. He stopped applying sunscreen a number of years back and has not washed his facial skin with any soap or other cleanser due to the discomfort it causes. Shaving has become a painful daily chore.

Gino, aged 34 years, is a computer engineer with an established career. He lives alone.

Gino enjoys being social and attends weekend parties and goes to the pub with friends. On one occasion, a female friend casually commented that his growing baldness made him look like a tired, 50-year-old businessman. Gino has been depressed since and constantly thinking about his baldness. He has started to feel a lack of confidence as a result. He is avoiding meeting clients face to face and is no longer spending time with his friends. He now spends hours in front of the mirror or looking at old pictures of himself, when he had a nice hairstyle in his younger days. He has started drinking alcohol more frequently as a result of stress/anxiety about his baldness.

Hiromi, aged 46 years, is an administrator who works for a large multinational company. She has an established career with a good income. She lives alone. She is lively and cheerful with no stresses. Hiromi has a healthy diet regimen and goes to the gym regularly. She has good sleep and does not snore. She is a non-smoker and occasionally drinks wine at social gatherings. There are no other medical issues of note.

Kirsty, a well-presented, stylish woman aged 28 years with enhanced long eyelashes and heavy make-up, is complaining of asymmetry in her cheeks. She has accentuated cheeks and chin, voluptuous lips and a defined, sharp nose.