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+A 21-year-old man presented to the emergency department with a rash on his arms and neck (figure 1).
+It had developed over the course of 36 h from discrete ‘pin prick’ areas of erythema into a maculopapular rash with vesicles (figure 2).
+It covered his forearms from the dorsal aspect of the hands to the flexor surface of the elbows.
+It was also beginning to develop around his neck (figure 3).
+He described the rash as itchy and painful, and was feeling ‘under the weather’.
+The patient had no previous dermatological or other medical history of note.
+He took no medication.
+He worked in a supermarket handling food items but there was no history of occupational chemical exposure.
+He had not recently had any change in washing powder or personal hygiene products.
+Physiological observations were entirely normal and systemic examination unremarkable.
+Closer examination of the rash revealed that it was present only on skin exposed to the sun when wearing a short-sleeved shirt; the most striking feature was the ‘V’ shape on the patient's chest in keeping with the neck line of a polo shirt.
+On further questioning the patient described a period of time 48 h prior to presentation (and 12 h prior to the development of the rash) spent strimming the grass under the hedges in his garden.
+Blood tests including full blood count, urea and electrolytes, liver function test and C-reactive protein were all within normal reference ranges.
+The list of potential differential diagnoses for a maculopapular rash is long, but given the distribution of the rash and the history of plant material exposure a diagnosis of phytophotodermatitis was made.
+The patient was discharged with chlorphenamine, simple analgesia and the advice to wear a long-sleeved t-shirt and sunscreen when gardening in the future.
+The rash resolved over a period of 3 weeks.
+It remained pruritic throughout healing but the associated pain settled over a few days.
+Residual scarring is beginning to fade 2 months after presentation.