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).

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Figure 1.

Figure 1.

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Figure 2.

Figure 2.


Based on the patient's history and physical examination findings, which one of the

Address correspondence to Shane L. Larson, MD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


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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.

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