JAMA Clinical Challenge

Vesicular Eruption

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.

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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.