A Middle-Aged Man With Vesiculobullous Lesions on His Feet and Hands

Lars Grimm, MD


June 30, 2015

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A 57-year-old man with a history of diabetes and hypertension presents to the emergency department with a 2-week history of vesiculobullous lesions on his feet and hands. The lesions first appeared on both of his feet and have been increasing in size and number; over the past several days, they have begun to develop on both of his palms and on the sides of the fingers. The patient was seen at a different clinic approximately 1 week ago and was given an ointment to treat the lesions; this has not resulted in any improvement. The lesions are extremely pruritic.

The patient has not had any recent travel history, and he lives alone, without any pets, in a regularly cleaned apartment. He has had no discernible new exposures and has not experienced any fevers or constitutional symptoms. The patient is on insulin, labetalol (Trandate®), and a combination pill of lisinopril/hydrochlorothiazide (Zestoretic®) plus omeprazole (Prilosec®); he has been on these medications for a long time and has had no prior complications. The patient has no known allergies.


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