Approach to common skin rashes Quiz: Ace Your Exams
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A 32-year-old woman presents to the emergency department for an intensely itchy rash on her bilateral hands, wrists, and feet. The rash has been present for six days and the itching is worse at night. She has not experienced malaise, fever, chills, or sweats. The patient has a history of schizophrenia with sporadic use of her prescribed medications and has been experiencing homelessness, recently residing in shelters. Temperature is 37.0°C (98.6°F), pulse is 92/min, respiratory rate is 20/min and blood pressure is 142/82 mmHg. On examination, she appears agitated, frequently scratching her hands and feet. Ears, eyes, nose, and throat examinations are within normal limits other than poor dentition. Cardiopulmonary exam is unremarkable. The skin rash, as pictured below, is seen on the bilateral hands, wrists, and feet. Excoriations are noted near the lesions on the feet. Which of the following is the most likely cause of her presentation?
Image is licensed under Public Domain, reproduced from WikiCommons
Image is licensed under Public Domain, reproduced from WikiCommons
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