Case report: A transient rash

Recently, during the very hot days of the summer, a number of patients have come to our walk-in clinic with a variety of summer-related problems.These range from injuries (such as from biking, gardening or swimming) to systemic issues such as fatigue and the seasonal increase in sunburn and exotic rashes. People seem to find poison ivy in more locations than I can imagine.A 24-year-old, fair-skinned man came to our clinic for help with a rash which had begun the previous evening and kept him awake because of itching. He was in good health, with no known allergies, no underlying illness and taking no medications. His rash had begun on his arm (which rapidly faded) but then affected his back, chest, legs—virtually everywhere. However, any specific lesion tended to fade rapidly, then recur elsewhere. He had no contact with anything new. No treatment had been used. Examination revealed scattered, widespread, slightly raised, pruritic erythematous patches of variable size and shape, on all body areas. His most recent area of concern was the inner aspect of his left upper thigh (see picture). The history and transient nature of the pruritic lesions suggested urticaria, but the rash did not have the usual appearance of hives.I felt that the rash was indeed an urticarial dermatitis and prescribed Rupall by mouth, with a recommendation not to scratch. When I explained the medication, the patient said, “I remember you told me the same thing and gave me Rupall when I saw you two years ago in the summer with the same rash.” He reported that the treatment was successful and worked very rapidly. I have seen many cases of recurrent idiopathic urticaria, but none so transient, fleeting and moving quickly around the body. The cause (as usual) was a mystery, apart possibly from hot summer weather. Such urticarial variants are not common in my experience, but do occur, at least in patients I have seen.

Case report: A transient rash

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