Presenter: Doug Richley DO, Emily Kollmann DO, Nicole Tillman DO , Gabriel Guerrero DO

Dermatology Program: Northeast Regional Medical Center

Program Director: David Cleaver DO FAOCD

Submitted on: February 4, 2016

CHIEF COMPLAINT:  New purpuric rash on the palmar hands, plantar feet, and perianal region

CLINICAL HISTORY: A 53-year-old female was referred to our office complaining of a new purpuric rash on the palmar hands, plantar feet, and perianal region. The patient reported the rash had been present for six days and she denied any pain or pruritus. She denied any systemic symptoms. No previous treatments. The patient admitted to methamphetamine use the night prior to the onset of the rash. Stating this was her first experience with methamphetamines however she has a known history of drug abuse. She was taking several oral medications daily however none were recently prescribed.

PHYSICAL EXAM:
On physical exam, purpuric erythematous macules and patches with superimposed bullae on the palmar hands, plantar feet, and perianally were noted.

LABORATORY TESTS: N/A

DERMATOHISTOPATHOLOGY:

A biopsy was significant for subepidermal bullae with a polymorphous perivascular and interstitial infiltrate with many eosinophils. There was no evidence of vascular damage or an occlusive process

DIFFERENTIAL DIAGNOSIS:

1.   Baboon Syndrome
2.   Fixed Drug Eruption
3.   Bullous Drug Eruption
4.   Intertrigo
5.   Allergic Contact Dermatitis