What is the diagnosis for this rash?


Key Clinical Message

The etiology of rash in a given patient can be so varied. Good history-taking is very important to prevent unnecessary work-up. In this patient with Churg-Strauss syndrome, the rash was due to “coining,” a traditional practice followed in Southeast Asian community and had no relation to her underlying disease.


A 46-year-old female with history of Churg-Strauss syndrome was seen for a flare-up and had the above skin changes. On further questioning, it was found that she had “coining” done.

Coining or “cao gio” in Vietnamese is a common traditional practice followed in the Southeast Asian community, as treatment for cough, fever, and headache. Heated oils containing herbs are rubbed onto the body and then a coin is rubbed vigorously in a linear fashion over the spine, along the ribs until a reddened area appears. The usual presentation is as linear abrasions/bruising, which take a few days to resolve.