Picture Quiz

A 38 year old Asian American woman comes to the office with a red painful ankle. The patient states that she sprained her right ankle two days ago by inverting it while walking. She believed it to be a minor sprain and did not go to a physician. However, she did apply a Chinese medicine patch that was given to her by her mother, who recently emigrated from China. The patient applied the medicine that was impregnated in a patch to the anterior medial and lateral portions of her ankle, leaving the posterior portion uncovered. The following day the patient broke out in a red and painful rash with blisters. The patient denies any fever or systemic symptoms. She does not know the ingredients in the medication. The rash is painful and the lesions made it painful to walk. Figures 1 and 2 show the patient's ankle at the time