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).
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.
REFERENCESshow 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.
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