Case report: A remote rash

On a cold, snowy winter’s day, I encountered a puzzling rash. A 58-year-old fair-skinned female sought an opinion about what to do about a rash. Actually, the rash was secondary to concern about the intense, constant itch which—like the rash—covered her entirely. With on-going COVID caution, the patient e-mailed the clinic a number of pictures of most areas of her body. Only palms and soles were spared. She then called, requesting diagnosis and treatment. Although I often rely on extensive history, the pictures and ensuing discussion provided almost “too much information.” Read: Case report: ‘I’m allergic to everything’ Unfortunately for the patient—and me—the diffuse rash was everywhere, and not sufficiently prominent to be the subject of a good picture. The picture attached, of her arm, is typical of the appearance of every square inch of her body. All the pictures were virtually identical and did not easily lend themselves to identity of location. All showed dry, erythematous, slightly scaling dermatitis—whose main feature was universality and itch. The patient had never had any previous rash, was in good health, no acute illness and not allergic to any medications. She took Pantoloc occasionally for heartburn, Ventolin very occasionally for cough, Claritin in the spring when she suffered from hay fever and clonazepam occasionally for anxiety. The rash and itch had begun suddenly (it didn’t look sudden) about one week prior to contact. History-taking revealed a great deal of information. She had her second COVID vaccine just after (she thought) the rash appeared. She had started using a new laundry detergent. She had taken one tablet of clonazepam. The rash persisted, unchanged by taking Aleve. She reported being under stress. The weather was cold and dry. The itch was worse at night (warmth?). With a background of atopy and a seriously itchy universal dermatitis—which really looked like dry skin, I concluded that the rash was eczematous and multifactorial in etiology—but should respond to my therapy of Rupall as an antihistamine and CeraVe moisturizing anti-itch cream. Any thoughts or suggestions would be appreciated. Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: A remote rash

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