A Pruritic Vesicular Eruption

Abstract

A 13-year-old black girl presented with a 2-week history of a generalized pruritic eruption. The eruption began on the anticubital fossae, with spread to her trunk and extremities over the subsequent 3 days. She had no history of fever, sore throat, nausea, or diarrhea. She had taken no medications.On physical examination, she was a well-appearing, scratching adolescent with 2-to 6-mm vesicles over her entire surface, except for her face and scalp (Fig 1). The palms and soles were also involved. Salmoncolored, oval, scaly, 1-to 3-cm patches were also present on her lower abdomen and chest (Figs 2 and 3).Histopathologic examination of a wrist vesicle revealed intraepidermal blister formation with spongiosis, lymphocytic exocytosis, and focal parakeratosis. There was also a superficial perivascular, mononuclear infiltrate (Fig 4). A periodic acid-Schiff stain was negative for fungal elements. Results from a rapid plasma reagin test were negative on presentation and again 2 weeks later. Viral cultures of the pa¬ tient's throat, rectum, and vesicular contents were negative.