Poison Ivy Case Studies

CC
Mr. Fagundo is a 52-year-old male here today complaining of poison ivy.
HPI
The patient tells me he was cutting his hedges on Tuesday, August 25th. He did not realize there was poison ivy in the hedging that he was working on. The following day, he noticed that his left arm was itchy and when he pulled up his sleeve, he saw a couple of red spots. He says that over the weekend, it seemed to get significantly worse. He has lots of red spots. He has some large vesicles. There has been some clear drainage coming from them, as well. In addition, he notices a little bit of swelling. He has a little bit in the upper arm on the left, but nothing on the right arm, a few areas on his chest wall and abdomen, as well. They do not seem to be as bad as his left arm. There has been no numbness or tingling in his arm. He has been trying to keep it covered as best he can. He said he looked up on WebMD and has been using cool baths and calamine lotion, which he does think is helpful. He has not had any fevers, chills, or body aches. No nausea, vomiting, or diarrhea and he is otherwise feeling well.
The patient was last seen in the office in July 2013 by my colleague, when he was ill. He has not been seen here for a physical since becoming established as a patient in 2011. He tells me he has been healthy.

Medications

Skin
He has a large area on the palmar side of his left arm with erythematous papules as well as large vesicular and almost bulla appearing lesions. Many of the areas in a linear configuration. The base of that appears to be erythematous. There is a small amount of swelling, as well. He has 2+ radial pulses, normal sensation throughout his hands, grossly. Less than two second cap refill. No swelling of the hand or the wrist itself. He also has several papules and one vesicular lesion on his upper abdomen and chest wall. Nothing on the right arm.