A 39-year-old woman with painful bullae and edema

A 39-year-old West African woman presented with a 3-day history of swelling, pain, and blisters on her hands, feet, and along the hair line on her scalp at the site of a black henna tattoo that had been applied 3 days earlier. She noticed swelling, tenderness, and blisters forming at all sites of henna application within hours. She otherwise felt systemically well. She immediately washed off the henna with water and soap. The physical examination revealed black henna tattoo on the dorsal aspects of her hands and feet with overlying erythema, bullae, and edema (Fig 1).

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