Reader Submission by Celestino Vega, MD, FAAFP, Angela Austin-Leyva, PA-C

A 14-year-old black girl of Haitian origin presents with a two-day history of blisters on her hands, with the larger of the two lesions on her left hand. She denies any aggravating or alleviating factors regarding her rash—no arthralgia, myalgia, fever, or abdominal pain. The patient also reports that the lesions are nonpruritic.

Further history reveals a previous erythematous rash on the torso that appeared a few days prior to the hand lesions. The patient denies any changes of personal hygiene products (eg, soaps, perfumes, or lotions), as well as any sexual behavior or drug use. Her only current medication is an antiseizure drug. The patient also reports that she traveled to Haiti two months ago.

Examination of the skin reveals a large bullous lesion on the palm of her left hand and a resolving bullous lesion, with multiple tense vesicles on the fingers, on her right hand. Maculopapular lesions with an erythematous base are noted on the torso, back, and arms. An ulcerative lesion is also noted on her inner left calf. Inspection of the soles of her feet reveals lesions similar to those found on the right hand; the interdigital spaces are spared. The patient’s oral mucosa is normal, although vesicular lesions are found on her lips. The remainder of the physical examination is within normal limits.

What is your diagnosis of this patient’s condition?