A 55-year-old woman with a history of high blood pressure and chronic obstructive pulmonary disease (COPD) attended her Primary Care clinic after developing sudden, painful red patches on her cheeks and neck, accompanied by a mild fever.
Her medical history included daily smoking (10 cigarettes) and ongoing treatment with enalapril for six years. For her lung condition, she had been using inhaled formoterol for two years. Following a recent worsening of symptoms, her pulmonologist replaced formoterol with a combination of indacaterol and glycopyrronium capsules.
Just two days after starting the new inhaler, the skin reaction appeared. The patient denied using new skincare products, changing her diet, or having cold symptoms, though she had recently been exposed to the sun with proper protection.
