Acute onset rash in a limited distribution

A fit and well man in his 60s presented to the dermatology urgent assessment clinic with a 4 week history of a worsening pruritic eruption, limited to his elbows and posterior legs. In view of the limited distribution, further questioning was directed towards identifying potential contact factors. In the 1-2 weeks before the rash onset, the patient identified having acquired a new reclining chair made of tanned leather. He reported daily morning episodes of running in his garden to the point of perspiration before lying in T-shirt and shorts upon his new leather recliner for 8 hours a day. Examination revealed a substantial follicular eruption comprising papules and pustules in a strikingly restricted distribution on both legs (fig 1). The distribution and the follicular …