Off-trail hike leads to severely pruritic rash – Let’s diagnose

A 23-year-old woman visited urgent care for a severely pruritic rash that had developed on her leg a couple of days prior and was spreading. On examination, there were multiple erythematous and edematous, vesiculated and crusted papules and plaques, some linear and some geometric in outline.

Two days prior to the rash onset, the patient had gone hiking with her dog. She recalled going off-trail and brushing up against woody vines and shrubs while chasing after her dog. She did not recall sustaining insect bites and noted that the sun was particularly intense that day, so she wondered if this may be a sun reaction. She appeared well and had no systemic symptoms.

What’s the diagnosis?

  1. Atopic dermatitis
  2. Arthropod bite or sting
  3. Urticaria
  4. Poison ivy dermatitis

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