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A 23-year-old woman presents with a severely pruritic rash that developed on her leg and is spreading. The patient reports that 2 days prior to onset, she had gone hiking with her dog. She recalls going off-trail and brushing up against “woody vines and shrubs.” She denies sustaining insect bites and notes that the sun was particularly intense that day, so she wonders if this may be a sun reaction. She appears well and has no systemic symptoms.
On examination, there are multiple erythematous and edematous, vesiculated and crusted papules and plaques; some are linear and some geometric in outline.
View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
