Work-Related Recurrent Neck Rash in Equine Professional
Case at a Glance
A 27-year-old female equine professional presents with recurrent painful neck rash that appears consistently during extended work periods and resolves during time off work.
Patient's Story
The patient is a horse show professional who works in rotating shifts of 1-2 weeks on, followed by 1-2 weeks off. She reports developing a painful, erythematous rash on her neck that has occurred at the end of every extended work period over the past few weeks. The rash appears after 5-7 days of consecutive work and resolves during her time off. She works outdoors with a traveling horse show team, a position she has held for several years without previous skin issues. The patient denies exposure to new substances, changes in skincare routine, or unusual stress levels. She notes that while she previously experienced facial flushing from temperature changes, this type of rash is new for her.
Initial Assessment
Physical examination revealed an erythematous, inflammatory rash localized to the neck area with associated skin dryness and flaking. The patient appeared otherwise well with no systemic symptoms. Current medications include Wellbutrin 300mg daily for depression and Concerta 54mg daily for ADHD. She was previously using tretinoin 0.1% but discontinued due to skin sensitivity during rash episodes.
The Diagnostic Journey
Initial treatment at an urgent care clinic included topical corticosteroid cream, which appeared to provide relief. However, the temporal relationship between work exposure and symptom onset/resolution raised suspicion for occupational contact dermatitis. The patient's work environment involves outdoor exposure and close contact with horses, hay, and various equine care products.
Final Diagnosis
Occupational contact dermatitis, likely allergic contact dermatitis based on the consistent temporal relationship with work exposure and resolution during time away from work.
Treatment Plan
- Continuation of topical corticosteroid during acute flares 2. Patch testing recommended to identify specific allergens 3. Implementation of protective measures during work (protective clothing, barrier creams) 4. Careful documentation of potential workplace exposures 5. Gradual reintroduction of tretinoin once acute dermatitis resolves
Outcome and Follow-up
Patient advised to maintain detailed log of workplace exposures and symptom patterns. Referral to dermatology for comprehensive patch testing to identify specific causative agents. Follow-up scheduled to assess response to protective measures and discuss long-term management strategies for occupational exposure.