A Middle-Aged Man with Vesiculobullous Lesions on His Feet and Hands
Background
A 57-year-old man with a history of diabetes mellitus and hypertension presents to the emergency department (ED) 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 last 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, and a combination pill of lisinopril/hydrochlorothiazide plus omeprazole; he has been on these medications for a long time and has had no prior complications. The patient has no known allergies.
On physical examination, the patient is well-appearing at rest, without any signs of undue anxiety or discomfort. His vital signs show a temperature of 98.7ºF (37.1ºC), blood pressure of 130/85 mm Hg, heart rate of 70 bpm, respiratory rate of 18 breaths/min, and oxygen saturation of 98% while breathing room air. Fluid-filled vesicles ranging in size from 1 mm to 3 cm are present on the instep and plantar aspects of his feet (see Figures 1 & 2). The vesicles are present on the palms of his hands and the sides of the fingers as well. The lesions are all skin-colored, without any surrounding erythema. No other lesions are found anywhere else on the patient's body. The lesions are nontender to palpation; additionally, his legs exhibit nonpitting edema up to the knees and reduced sensation to light touch, both long-standing conditions. The oropharynx is clear of any lesions, and the rest of the physical examination is unremarkable.
What is the skin condition being described?
Hint: Pay particular attention to the anatomic clustering of the lesions
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