Shingles Strikes With a Vengeance

2. A 38-year-old man presents with an itchy, blistery rash that usually appears in the summer, getting worse each year. The lesions are collections of vesicles with faint underlying erythema that crisscross his legs in linear configurations. Smaller but similar lesions are scattered over his arms and trunk.

Diagnosis: The rash produced by poison ivy exposure can be severe and can last six weeks or more without treatment. Poison ivy is not contagious, cannot be spread by scratching, and (despite its name) is not poisonous in any way. The number of poison ivy plants has doubled in the past 50 years and is expected to double again within 20 years. The potency of the plant’s allergen is also expected to increase. The patient (height, 6’3”; weight, > 300 lb) was treated with a 60-mg IM injection of triamcinolone, a two-week, 40-mg taper of prednisone, and twice-daily application of betamethasone cream. This, of course, followed a discussion of the risks versus benefits of such a course of action.

For more information, see “He Tried So Hard to Avoid It … .” Clinician Reviews. 2015 July;25(7):W2.