This 45 year old man came to the office complaining of this localized rash for the past 4 days (see photo). It was not painful, but felt “prickly”. It did itch and was sensitive to touch. He had no other medical illnesses and took no prescribed medications. He is happily married, does not smoke and occasionally drinks alcohol on the weekends. There has been no changes in the laundry detergent or exposure to any poison-ivy or poison-oak. He has never had anything like this before.

Feel free to post your guesses in the comments section.