Photo Quiz

An Activity-Induced Rash

 

Am Fam Physician. 2016 Nov 1;94(9):735-736.

A 50-year-old man presented with a history of rashes on his back, chest, and upper extremities that appeared after physical activity, such as exercise or yard work. The rashes began five months earlier. He reported occasional itching and hives that appeared after scratching. He did not have nausea, vomiting, choking sensation, or difficulty breathing. He had not used any new lotions, soaps, cologne, or detergents. He had a history of hyperlipidemia, for which he was taking simvastatin (Zocor). His family history was unremarkable.

On physical examination, he initially did not have a skin rash or lesions. He had normal skin turgor and temperature. When pressure was applied to the skin, an erythematous patch formed (Figure 1) and progressed to a wheal after approximately five minutes (Figure 2).


Figure 1.


Figure 2.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Cholinergic urticaria.

B. Fixed drug reaction.

C. Irritant contact dermatitis.

D. Urticarial vasculitis.

Address correspondence to Shane L. Larson, MD, at shane.l.larson.mil@mail.mil. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Montgomery SL. Cholinergic urticaria and exercise-induced anaphylaxis. Curr Sports Med Rep. 2015;14(1):61–63....

2. Hosey RG, Carek PJ, Goo A. Exercise-induced anaphylaxis and urticaria. Am Fam Physician. 2001;64(8):1367–1372.

3. Flowers H, Brodell R, Brents M, Wyatt JP. Fixed drug eruptions: presentation, diagnosis, and management. South Med J. 2014;107(11):724–727.

4. Usatine RP, Riojas M. Management of contact dermatitis. Am Fam Physician. 2010;82(3):249–255.

5. Schaefer P. Urticaria: evaluation and treatment. Am Fam Physician. 2011;83(9):1078–1084.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

A collection of Photo Quiz published in AFP is available at http://www.aafp.org/afp/photoquiz.

Previously published Photo Quizzes are now featured in a mobile app. Get more information at http://www.aafp.org/afp/apps.

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to afpphoto@aafp.org.


 

Copyright © 2016 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


MOST RECENT ISSUE


Dec 1, 2016

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article