Rash in the returned traveller.

CASE STUDY: An otherwise healthy male patient, 45 years of age, presented to a general practice clinic in regional Western Australia 1 week after developing a pruritic, spreading rash that started after returning from a holiday in Thailand with his family. He denied infective symptoms such as fever, rigors or chills. He had not been bitten by either mosquitoes or marine life during his stay. Examination revealed rash in several distinct areas over the left flank (Figure 1). The rash was erythematous and serpiginous (Figure 2). Some excoriations were present. He was afebrile and did not have any palpable lymphadenopathy. The general practitioner was in doubt as to the diagnosis and sought assistance through Tele-Derm National, a service provided by the Australian College of Rural and Remote Medicine (ACCRM). The GP submitted brief case notes and several photographs of the rash via the online portal. Within the hour, a diagnostic and management plan was prepared by a dermatologist and an SMS notification of the findings sent to the referring GP.