Intended for healthcare professionals

Endgames Spot Diagnosis

Acute onset rash in a limited distribution

BMJ 2020; 370 doi: (Published 06 August 2020) Cite this as: BMJ 2020;370:m2626
  1. Remus T Winn, dermatology specialist registrar,
  2. Suzy Leech, dermatology consultant
  1. Royal Victoria Infirmary, Dermatology Department, Newcastle-Upon-Tyne, UK
  1. Correspondence to RT Winn Remuswinn{at}

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 …

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