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Itchy, circular rash on forearms etc aggravated by sun and/or heat
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Itchy, circular rash on forearms etc aggravated by sun and/or heat

Hi!

I've had a recurrent rash for over 4 years now. Actually, I think it is there year-long but flares in the early spring (Feb/March) and is more visible and itchy throughout the summer, returning to a low level in the fall and winter.

The sequence is as follows: in Feb/Mar I get red circular patches at the corner of my mouth running down diagonally between mu chin and cheek (mostly on one side). I may get other small flares, but this is the main patch. The rash is, as mentioned, circular, with a slightly raised pinkish border. If I scratch at the border I sometimes pull out a small plug with a white root.

A red rash then appears on my hands, usually between my thumb and forefinger, in March April. This rash eventually spreads to my forearms and lower legs (though it is never as visible on my legs - I just know it's there by the itchiness). The rash on my forearms gets more pronounced (itchier and redder) with the heat and sun. I'm not sure which is aggravating it. Also, the pigmentation on my arm eventually becomes patchy.

Because I have relatively dark skin for a Caucasian woman, the redness of the rash is not extremely visible and most doctors and dermatologists have not been able to diagnose it or have misdiagnosed it. I have tried a variety of cortisone creams, etc without success.

I am wondering if it could be fungal. One dermatologist mentioned possibly trying a strong anti-fungal pill, but mentioned liver damage as a possible side effect, and seemed hesitant to prescribe it without a more certain diagnosis.

Another dermatologist thought I had a sun allergy and prescribed a strong sunscreen. I am not convinced of the this diagnosis either as the rash remains thoughout the year now. However, the rash is restricted to my face and lower limbs - areas most exposed to the sun - so there is some link. But if it is the sun, the effect is not immediate, and the rash never totally disappears.

I have never had this rash on my trunk or groin area. My head does get very itchy though, as does my face in general. This is at its worst in the spring/early summer and then in the summer, it is my forearms, then forearms and lower legs and eventually also my upper arms.

Any help would be appreciated. Thanks!
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Avatar_f_tn
Hi,
Cholinergic urticaria is a subcategory of physical urticaria (aka hives) that is a skin rash brought on by a hypersensitive reaction to body heat. Symptoms follow any stimulus to sweat such as exercise , heat from the sun, saunas, hot showers , spicy foods which may cause an increase in body temperature or even stress due to blushing or anger. Some people only have symptoms during the winter months where their body temperature rises when it is unacclimatized to heat.
The affected area will often feel warm and can be extremely itchy or exhibit a burning sensation. Typically the rash occurs on the upper trunk and the arms but can appear on other parts of the body.
The rash typically develops within a few minutes of a rise in body temperature but can take longer to appear visibly on the skin. The visible rash is often preceded by a general warming of the skin or itchiness.
Cholinergic urticaria is a fairly common type of hives and is often combined with other forms of urticaria, especially chronic urticaria. There is some evidence that in at least some individuals the condition is hereditary.
Drug treatment is typically in the form of antihistamines such as loratadine (Claritin), hydroxyzine, cetirizine.Applying Calamine lotion on the itchy skin reduces the irritation.
ref:http://en.wikipedia.org/wiki/Cholinergic_urticaria

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Avatar_f_tn
Thank you for your comments.

I am wondering if it can be what you suggest in light of the cyclicity (annual). For four years now the pattern has been the same - mouth, then hands, then forearms, then legs and upper arms. If it were the heat rash, wouldn't everything flare at once?
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Avatar_n_tn
FOR 13 YEARS I HAVE SUFFERED FROM AN EXTREMLLY ITCHY RASH DUE TO HEAT. DOCTORS SAY THERE IS NOTHING FOR IT. I CANT KEEP LIVING LIKE THIS, AND WITH THIS HORRIBLE TO LOOK AT RASH. PLEASE DO YOU HAVE ANSWERS?
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