JAMA Clinical Challenge Section Editor: Huan J. Chang, MD, Contributing Editor. We encourage authors to submit papers for consideration as a JAMA Clinical Challenge. Please contact Dr Chang at firstname.lastname@example.org
Author Affiliations: Center for Clinical Studies, Houston, Texas (Dr Gordon); Department of Dermatology, University of Texas Health Science Center, Houston (Dr Tyring); and Center for Clinical Studies, Webster, Texas (Dr Tyring).
A 49-year-old man with a history of severe eczema presents to your office with slightly eroded, erythematous scaly patches on his face, chest, and back. You prescribe oral doxycycline hyclate, 150 mg/d, to avoid bacterial infection and tacrolimus ointment, 0.1%. After 5 days, he returns to your office with painful, umbilicated vesicles on his face, ears, neck and chest, and back (Figure 1). He is afebrile and denies systemic symptoms; he has no known drug allergies and denies having complications due to tetracyclines in the past. He takes no additional medications.
Gordon R, Tyring S. Vesicular Eruption. JAMA. 2012;307(14):1528-1529. doi:10.1001/jama.2012.436