Yard Rash

70 y old gentleman was performing some yard work over the weekend. Over the next 48 hrs, he noticed a very pruritic rash that spread quickly from his arms to forearms, face and legs. His wife rubbed calamine lotion and OTC hydrocortisone, which provided some relief. His past history is relevant for HTN and BPH, well controlled on metoprolol, Enalapril and doxazosin. On exam, his vital signs are stable, although he looks miserable from extreme pruritus. He has large areas of weeping vesicular eruption on his face, arms and legs, surrounded by erythema and edema.

What is the first line of treatment for his condition?

1. Topical Clobetasol propionate 0.05%
2. Topical Pimecrolimus
3. Avoid contact with vesicles
4. Methylprednisolone dose pack tapered over 1 week
5. Prednisone taper over two weeks starting at 1mg/kg/day (Maximum 60mg/d)