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JAMA Clinical Challenge

Vesicular Eruption

Painful, umbilicated vesicles on the patient's face and neck.

Rachel Gordon, MD
Stephen Tyring, MD, PhD
A 49-year-old man with a history of severe eczema presents to your office with slightly eroded, erythematous scaly patches on the his face, chest, and back. You prescribe oral doxycycline hyclate, 150 mg/d, to avoid bacterial infection and tacrolimus ointment, 0.1%. After 5 days, he returns to your office with painful, umbilicated vesicles on his face, ears, neck and chest, and back ( Figure). He is afebrile and denies systemic symptoms; he has no known drug allergies and denies having complications due to tetracyclines in the past. He takes no additional medications.

See the full article for an explanation and discussion.

Author Affiliations: Dr Gordon (rgordon{at}ccstexas.com) is affiliated with the Center for Clinical Studies, Houston, Texas; Dr Tyring is affiliated with the Department of Dermatology, University of Texas Health Science Center, Houston, and the Center for Clinical Studies, Webster, Texas.