A 16-year-old African American boy presented to the emergency department with a 2-week history of an enlarging focus of erythema and induration over his right elbow. His symptoms reportedly began with the localized onset of pruritic papules that coalesced to form a large plaque. After 1 week, the region had become markedly indurated, with weeping of serous fluids, and the patient was seen by a local physician, who prescribed cephalexin. Despite the antibiotic therapy, the inflammation and induration continued to worsen.
Segal JM, Rao C, Shea CR, Prose NS. Recurrent Vesicles, Papules, and Plaques in a Teenager—Quiz Case. Arch Dermatol. 2003;139(7):933-938. doi:10.1001/archderm.139.7.933-a