Vesico-bullous rash caused by pompholyx eczema

Abstract

DESCRIPTIONA 31-year-old man presented to dermatology with a 4 day history of an intensely itchy, linear, vesicular rash affecting the palms of both hands, on the background of recent exposure to a patient with scabies. The patient had a history of childhood eczema and asthma but no exacerbations in adulthood. Examination and microscopy revealed a vesicular rash with an absence of any burrows, mites or eggs. A provisional diagnosis of pompholyx eczema was made and the patient was commenced on mild topical corticosteroids. The patient re-presented 5 days later with worsening symptoms and a severe vesico-bullous rash ( fi gure 1 ) and was commenced on oral prednisolone and high strength topical corticosteroids. Symptoms initially continued to progress for 2 further days with enlarging of the bullae ( fi gure 2 ). The image demonstrates the coalescence of vesicles to form tense bullae adjacent to areas of multiple vesicles ( fi gure 3 ).