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Blisters can be related to bug bites, contact allergy, friction, drug reaction,
vasculitis, primary genetic disease of the skin, and fluid overload. A full
discussion of blisters can be found in Chapter 67 Rash: Vesiculobullous . Chapter
70 Rash: Papulosquamous Eruptions and Viral Exanthems , covers HSV and
Chapter 65 Rash: Atopic/Contact Dermatitis and Photosensitivity , covers eczema
herpeticum.

Localized Eruptions Without Fever
Contact dermatitis, insect bites, papular acrodermatitis, and scabies usually
present in a localized distribution; however, all may appear as a more generalized
eruption in extensive cases.
Contact Dermatitis
Contact dermatitis may be caused either by a primary exposure to an irritant or by
an acquired delayed hypersensitivity response to a sensitizing substance. A sharp
demarcation commonly exists between the involved and uninvolved skin areas.
Affected skin is erythematous with variable numbers and combinations of
macules, papules, vesicles, and/or bullae.
Diagnosis depends on obtaining a thorough history of exposure and the
presence of a characteristic localized pattern of rash. Treatment for both types of
these dermatitides includes eliminating exposure to offending irritants, providing
topical or systemic antipruritic agents, and for more severe cases, providing
topical or systemic steroids. Please see Chapter 65 Rash: Atopic/Contact
Dermatitis and Photosensitivity for additional information.
Insect Bites
Virtually all children experience insect bites. Mosquitoes, fleas, and bedbugs are
the most common offenders. Diagnosis depends on the season, the climate,
exposure to animals, and distribution and appearance of the lesions. Care is aimed
at minimizing discomfort with topical or systemic antihistamines and/or topical
steroids.
Papular Acrodermatitis (Gianotti–Crosti Syndrome)
Papular acrodermatitis is an eruption of unclear cause that has been associated

with hepatitis B, EBV, and other viral infections in young children, including a
similar reaction in the setting of MC. In the pediatric population, 85% are
younger than 3 years. The eruption may follow a low-grade fever or mild upper
respiratory symptoms.