MS is a 77 y/o women who presents with a rash. The rash began one week ago and firth appeared on back and extended to her abdomen on the left side. She firth noticed the rash after working in her garden. For the firth 3 day she had no associated symptoms,bowever on the 4 day , she begen to experience severe pain"like being stung by a bee" The pain is worse in the evenings and she is having difficulty sleeping. She bas been taking Tylenol every 4-6 hours and using vitamin E lotion with minimal relief. She may have poison ivy.