Patients often utilize the emergency department as a provider of primary care or as an avenue to obtain a “second opinion.” Rashes are a common chief complaint in the emergency department and can often be the most puzzling for practitioners to diagnose. Atypical presentations, variations, and secondary lesions can be especially challenging. The emergency practitioner must perform a thorough history and physical, including current treatment for preexisting skin conditions. While the majority of patients with a rash who present to the emergency department have only a minor condition, a reported phenomenon associated with dermatitis is a dermatophytid reaction. The ability to recognize this phenomenon is crucial as misdiagnosing can have lasting consequences.