Case presentation A 65-year-old female consulted her family physician through email with concerns about a rash (Cover image A) that appeared the previous day on both lower limbs. Medical history Obesity, diabetes mellitus, dyslipidemia, and Wolff-Parkinson-White syndrome Current medications: Metformin and atorvastatin Exercises twice weekly No history of smoking, alcohol use, dermatologic, or rheumatologic disease Lipoma excision in 2016 Vaccinations up to date Recent travel history Recently vacationed in the Madeira Archipelago Linked rash onset to high temperatures and humidity Engaged in long daily walks, hiking, and frequent water exposure Notably, areas covered by socks were unaffected Telephone consultation Photographs sent by the patient revealed: Circumferential erythematous exanthema on both lower limbs above the ankles Petechial lesions around 1 cm in diameter The rash…