This healthy adolescent developed itchy red papules and crusts on his anterior neck. The next morning the eruption spread to his face, chest, shoulders and arms. The lesions were sharply demarcated and in some areas linear. He developed edema of his eye lids progressing to closure of his right eye. Initial concern regarding the possibility of facial cellulitis and staphylococcal scalded skin syndrome resulted in his admission to the hospital and treatment with parenteral clindamycin. He had no fever, his complete blood count was normal except for a mild eosinophilia, and the rash worsened on treatment. The following day, when skin and blood cultures were noted to be negative, he was started with oral prednisolone, cool compresses, the antibiotic was discontinued, and he was discharged home. Within 24 hours the eruption was markedly improved and the next day he was feeling well, his eye was open, the eruption had almost completely resolved, and her returned to school.
asymmetric, sharply demarcated, edematous red papules, patches, plaques some with yellow exudates and crusts