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Karen is a 49 year old manager and presents very distressed as her face has started to flush a lot and she has developed spots around her nose. Her work involves dealing with the public and she is very self-conscious about her appearance. She is not certain about triggers but thinks there may be link to stress at work and the recent hot weather.

The spots appear to be papules and pustules and involve the mid face area. What is her most likely diagnosis?

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