A 26-year-old previously prescribed and currently taking valproic acid and phenytoin for epilepsy presented to the clinic with a 2-month history of gradually worsening pruritic plaques that initially involved the scalp, face, and neck, and later affected the anterior and posterior chest wall, abdomen, upper arms, and thighs; she also had nodules over the nose and cheeks (Cover image). It was thought that she developed exfoliative dermatitis secondary to valproic acid and phenytoin. Medications were switched to levetiracetam, and a tapering dose of steroid was prescribed. Her skin lesions slightly improved.
Two months later, she developed diffuse urticarial lesions of varying sizes over the old plaques. These lesions were well-defined with demarcated borders and were minimally pruritic at the time. Given that her condition worsened despite changing her medication, the lesions were…
