A previously healthy 55-year-old patient presents with a four-month history of the pictured indurated papules and plaques. History does not reveal prior skin problems. The lesions started on the cheeks and are now affecting the forehead. The sun seems to exacerbate the condition, causing mild burning and pruritus. Patient complains of cheek swelling that worsens in the morning and improves as the day progresses. Prior treatments included oral doxycycline, sulfur-based face washes, and topical metronidazole, all with minimal improvement. Which of the following medications is most appropriate for this condition?

A. Oral metronidazole

B. Isotretinoin

C. Propranolol

D. Topical permethrin

E. Tretinoin cream

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