A 17-year-old adolescent girl presents with a pruritic rash localized to the wrist and chest at the sternal notch. Papules and vesicles are noted in a bandlike pattern, with oozing from some lesions.
Which of the following is the most likely cause of the rash?
A. Herpes simplexContact dermatitis causes pruritic plaques or vesicles localized to an area of contact. In this case, nickel in her bracelet and pendant is the inciting agent. Contact dermatitis may produce vesicles with weeping lesions. The process may be related to direct irritation of the skin from a chemical or physical irritant or may be immune mediated. Herpes simplex produces grouped vesicles, but they are painful and are unlikely to occur around the wrist. Herpes zoster is painful and occurs in a dermatomal distribution. Atopic dermatitis usually affects skin creases (especially the antecubital fossae) and the hands. It may be vesicular but is more often associated with skin thickening (lichenification) as a result of constant scratching. Seborrheic dermatitis presents as red, scaly nonpruritic lesions localized to the eyebrows, nasolabial folds, scalp, and retroauricular areas.