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Recurring photoaggravated rash in a blaschkoid distribution

A 62-year-old white man presented with a 6-year history of a recurrent pruritic rash on the right side of his chest occurring mainly in the summer, usually after holidays in sunny locations. The rash would persist for a few weeks and would then resolve almost completely. On physical examination, a rash was seen on the right side of the lower chest, consisting of flat-topped erythematous papules in a blaschkoid distribution (Figs 1a,b). The initial differential diagnosis included various inflammatory conditions occurring in a blaschkoid distribution, such as lichen planus, lichen striatus, lupus erythematosus, psoriasis and adult blaschkitis. In view of the history of photoaggravation, phototesting was considered. However, when the patient was reviewed a few weeks later, the inflammatory lesions had cleared, leaving minimally erythematous, scaling papules, again in a blaschkoid distribution, at the same site (Fig. 1c).