A 40-year-old white man presented with an acute bilateral periorbital eruption 8 years after undergoing a cardiac transplantation. He related the onset of eyelid pruritus to the initiation of pravastatin therapy. Subsequent erythema, crusting, and edema prompted a dermatologic evaluation. He denied constitutional symptoms. Occupational exposures included frequent hand washing and the use of vinyl gloves. He had a history of eyelid irritant dermatitis, which was under control. One week before the onset of the eruption, the dosage of his mycophenolate mofetil therapy had been increased from 1 to 1.5 g/d.

Physical examination revealed numerous 4- to 5-mm erythematous excoriated papules, most of which had a central eschar, involving all eyelids (Figure 1). There were no pustules or vesicles. The bulbar and palpebral conjunctivae were unremarkable. Bacterial and viral cultures were obtained, and a biopsy was performed (Figure 2).