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An acute linear pruritic eruption following allergic contact dermatitis.

42 DIAGNOSTIC DILEMMAS IN DERMATOLOGY Case Report A 39-year-old man presented to the emergency department with an abscess in the left axilla that was treated with incision and drainage and a 10-day course of trimethoprim/sulfamethoxazole. Two days later, he reported worsening erythema and tenderness at the abscess site. While changing the wound dressing, he noticed that the skin under the adhesive tape was red and irritated. Concerned about an allergic reaction to the adhesive tape, he avoided further use. The following day, he developed an acute, symmetric, pruritic eruption in previously unaffected skin on the arms and hands. He was otherwise well without systemic complaints. He had previously tolerated trimethoprim/sulfamethoxazole without any adverse effects and had no prior history of eczema or other dermatitis. Physical examination revealed a tender, erythematous, fluctuant cyst in the mid left axilla. Geometric erythema and a superficial erosion were most prominent medial to the cyst at the site of the applied adhesive tape (Figure 1). The forearms and dorsal hands demonstrated numerous 0.1 to 0.2cm nonfollicular, clear-towhite papules and papulovesicles (Figure 2), many of which were arranged in a linear distribution (Figure 3). The trunk, legs, and feet were uninvolved. Results of a complete blood cell count and basic metabolic panel were unremarkable. Bacterial culture of the left axillary abscess demonstrated few methicillin-resistant Staphylococcus aureus. A biopsy of the linear lesions on the right forearm was performed for histopathologic examination (Figure 4).