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A 28 year old women having a long history of acne from her teens and having had numerous treatments for it, presented with an eighteen month history of right sided hemifacial flushing and excessive sweating with anhidrosis on the left side. The asymmetry in skin appearance was particularly noted after exertion. There was no other neurological abnormality. MRIS of her head, cervical spine and dorsal spine failed to reveal any structural cause for this. We tried botulinum injection without any success. She showed signs of improvement with selective serotonin reuptake inhibitors.