Erythema and blistering after sun exposure in a 12‐year‐old boy

Abstract

A previously healthy 12-year-old boy presented to the emergency room with severe pain, erythema, and blistering on his dorsal hands and feet after prolonged sun exposure 3 days prior. The caregiver reported that since the age of 4, the patient has had several episodes of rash after sun exposure. In total, he has had 4 to 5 episodes, with the current outbreak being the most severe. He reported that he does not always get a rash after sun exposure, but it is worsened by sunscreens. The family reported that he had previously been diagnosed with a "sunscreen allergy" and thus had not been using sun protection this summer. Physical examination was significant for well-defined erythematous to violaceous patches and macules studded with vesicles on the dorsal hands and dorsal feet. There were well-demarcated areas of sparing at sites of a previous bandage sandal strap (Figures 1 and 2). The bilateral malar cheeks and nasal bridge demonstrated erythematous patches. A 4-mm punch biopsy was obtained from the right dorsal hand (Figure 3).