Peer Reviewed


What Is the Cause of These Papules?

David L. Kaplan, MD—Series Editor

Kaplan DL. What is the cause of these papules? Consultant. 2018;58(7):163-164. 


This 45-year-old man presented with tender papules on the palms and soles of 2 to 3 days’ duration (Figure 1). He had acquired acute contact dermatitis 2 weeks ago from poison ivy while doing yardwork (Figures 2 and 3), but the pruritus had been so mild that he elected not to seek treatment. He was otherwise healthy and denied any recent upper respiratory tract infections or a history of herpes simplex. He had had no poison ivy rash on his hands 2 weeks ago.

erythema multifome

erythema multifome

erythema multifome


Answer: Erythema multiforme complicating poison ivy

erythema multifome

erythema multifome

erythema multifome

This patient had erythema multiforme following a rhus-induced allergic contact dermatitis. While this association has been previously documented,1-3 the paucity of cases in the literature along with my experience suggests that poison ivy–induced erythema multiforme is an underreported phenomenon.

This patient’s reaction responded quickly to a short course of systemic corticosteroids.

Hand-foot-and-mouth disease is typically seen with an upper respiratory tract infection with oral lesions. Contact dermatitis would be itchy, not tender. Dyshidrosis would present as tiny vesicles that are itchy but not tender. 

David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.


  1. Schwartz RS, Downham TF II. Erythema multiforme associated with Rhus contact dermatitis. Cutis. 1981;27(1):85-86.
  2. Cohen LM, Cohen JL. Erythema multiforme associated with contact dermatitis to poison ivy: three cases and a review of the literature. Cutis. 1998;62(3):139-142.
  3. Werchniak AE, Schwarzenberger K. Poison ivy: an underreported cause of erythema multiforme. J Am Acad Dermatol. 2004;51(5 suppl):S159-S160.