A 30-year-old woman presents to the clinic complaining that she has “an itchy rash all over the…

A 30-year-old woman presents to the clinic complaining that
she has “an itchy rash all over the place.” She noticed that her legs became
red, itchy, and blistered about 2 days after she had been hiking in a heavily
wooded area. She says that scratching broke the blisters, and afterward the
rash became much worse and spread all over. She is convinced that the rash
could not be poison ivy because once before she was exposed to that plan  and
did not develop a rash. On examination, there are erythematous vesicles and
bullae in linear streaks on both of her legs. Some areas are weepy, with
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A 30-year-old woman presents to the clinic complaining that
she has “an itchy rash all over the place.” She noticed that her legs became
red, itchy, and blistered about 2 days after she had been hiking in a heavily
wooded area. She says that scratching broke the blisters, and afterward the
rash became much worse and spread all over. She is convinced that the rash
could not be poison ivy because once before she was exposed to that plan  and
did not develop a rash. On examination, there are erythematous vesicles and
bullae in linear streaks on both of her legs. Some areas are weepy, with a
yellowish crust. There are ill-defined erythematous plaques studded with
papulovesicles on the trunk and arms.

Questions

A. What is the likely diagnosis? What feature on the
physical examination is the cardinal sign?

B. What made the eruption spread?

C. How do you explain the diagnosis to the patient in light
of the fact that she did not develop a rash after known exposure to poison ivy
in the past? Why didn’t the rash appear until 2 days after the apparent
exposure?

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