17-year-old male with quickly spreading rash

The correct diagnosis is severe type IV delayed hypersensitivity contact dermatitis caused by exposure to poison ivy. The effects were so dramatic because of the mode of exposure: campfire smoke. Airborne rhus allergen (the allergen in poison ivy) can cause a type IV reaction. The time course for the reaction to reach full fruition can be quite prolonged.

Treatment for severe poison ivy dermatitis includes a course of oral prednisone, starting at 1 mg/kg/day (up to 80 mg) and tapering over at least 14 days, or longer for more severe reactions. A six-day tapering steroid Dosepak should not be prescribed, as the reaction will actually rebound once the short course is over.
Case presented by Logical Images, Inc.
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