A 43-year-old African-American woman was seen for a rash on her right hand and neck. The rash appeared 2 weeks earlier, and was itchy. The patient had been applying alcohol directly to the affected skin.
The patient said she had experienced rashes on and off during her adult life. She has not worn necklaces for years because they irritate the skin around her neck. She also cannot wear wool clothing or any shirts with bright colors. She had not discussed this with a physician before, and she did not know why her skin is so sensitive.
The patient was not taking any new medications, using new bath products, or wearing new clothing before the rash appeared. However, she did remember getting new perfume 2 weeks earlier. She did not have asthma, but did have a mild hay fever. She was adopted and therefore did not know her biologic family’s medical history.
On close inspection, prominent erythema was seen around her neck and on the dorsum of her right hand (Figures 1 and 2).
FIGURE 1
Itchy rash on the neck…
FIGURE 2
…and the right hand
What is the diagnosis?
What are the management options?