An adolescent developed an itchy rash on the top of her right foot. She opened tetracycline capsules and rubbed the contents of the capsules over the foot dermatitis. The rash progressed to blisters over a week when she erupted with widespread pruritic papules. She has no history of atopic dermatitis, tinea pedis or any preceding foot dermatitis. Although the cause of the primary dermatitis is unclear, the rash and clinical course is typical of a severe contact allergic dermatitis followed by an id reaction. She cleared on a tapering course of oral steroids, and she will be patch tested as soon as possible.
confluent crusted red edematous papules around bullae and macerated crusts