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Dr Le Fanu's collection of ‘mystery syndromes’ (March 2002 JRSM1) contains a case that is no mystery. The ‘walker's ankle rash’, though surprising to those affected, is friction dermatitis—a form of irritant contact dermatitis. The eruption, which I have experienced, can be florid in appearance and unpleasantly symptomatic with troublesome itching on a background of tender skin. It responds rapidly to treatment with an emollient such as Nivea, E45 or whatever is available in the nearest village shop. No topical corticosteroid is needed. There is no need to interrupt the walking holiday.
The skin just above the tops of the walking boots is unaccustomed to the friction of boots through socks, applied for several hours in a day, possibly in wet and cold weather conditions. A further factor is that the skin becomes drier and more susceptible with age; friction that caused no trouble last year may be too much this year and subsequently.