A 49-year-old man has had intermittent eruptions of itchy blisters on both of his palms for the past 15 years. The lesions heal after 2 to 3 weeks and then occur again after 6 months. He suspects that they are caused by poison ivy, but he is unsure of where he would have been exposed to the plant.
The patient is a military pilot. He takes no medications and has no other rashes.
What is your clinical impression?
A. Contact dermatitis.
B. Erythema multiforme.
D. Lichen planus.
Bonus question: What additional history might be relevant?
1. Auquier-Dunant A, Mockenhaupt M, Naldi L, et al; SCAR Study Group. Severe Cutaneous Adverse Reactions. Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis: results of an international prospective study. Arch Dermatol. 2002;138:1019-1024.
2. Viral infections. In: Neville BW, Damm DD, Allen CM, Bouquot JE, eds. Oral and Maxillofacial Pathology. 3rd ed. Philadelphia: Elsevier Health Sciences; 2008:240-284.