Recurrent Episodes of Painful and Pruritic Red Skin Lesions

Abstract

A healthy, afebrile, 24-year-old Hispanic woman presented with recurrent, painful, itchy, red skin lesions of 2 month’s duration. She had recently arrived from Nicaragua and was living with relatives in Houston, TX, USA. Erythematous plaques initially appeared on her right hip and elbow. Dermatitis was considered. Her skin lesions improved after being treated with topical triamcinolone acetonide 0.1% cream and oral hydroxyzine (50mg) once to three times daily. Shortly thereafter, tender erythematous areas of swelling developed on her right elbow and distal arm. Cellulitis was suspected. The sites resolved after she received oral amoxicillin (250mg every 8 hours for 7 days). Her third episode of lesions was evaluated at a dermatology clinic. She was afebrile. Initially, there was erythema and massive edema of the left upper eyelid (figure 1a). This began to improve within the next 48 hours (figure 1b). However, new, painful, pruritic, erythematous, firm nodules appeared on her right ear, forehead, preauricular and inferior cheek (figure 1c), and dorsal hand. A lesional skin biopsy from her right preauricular cheek and laboratory studies were performed.