A 5-year-old Saddlebred gelding was presented for the evaluation of nonseasonal chronic progressive dermatitis that began at 1 year of age. The dermatitis started as a linear area of crusting and scaling on the lateral aspect of the left shoulder that would resolve in the spring and summer months. However, for the previous 3 years the lesions progressed and were present year round. Many topical and systemic treatments had been used over the 3-year period with no clinically appreciable response, including penicillin injections (dosage unknown), antifungal topical agents, iodine baths, and prednisolone (1 mg/kg PO q24h for 14 days then tapered over 30 days).For the previous 2 years, nonseasonal pruritic urticaria occurred when the horse would sweat. The pruritus was graded as 9/10 with 10 representing severe pruritus. The intensity of the pruritus limited the horse's ability to work and had increased each year. The pruritus was manifested as stomping, biting at the sides, forceful tail whipping, refusing to stand in place, extreme anxiousness, and rubbing. The urticaria subsided within 20 minutes of working, as did the pruritus. Baths with lukewarm water immediately after working controlled the pruritus. Preemptive 14-day courses of hydroxyzine pamonate (2 mg/kg q8h) and chlorpheniramine (0.5 mg/kg q12h) were ineffective.On physical examination, generalized distribution of circular to annular areas that had varying degrees of crusting and alopecia, moderate-to-severe scaling, and mild leukoderma was present. Although the lesions were generalized, the most severely affected regions included the face, neck, chest, lateral thorax, and the proximal aspect of all 4 limbs. Two smaller focal areas of thick crusts were removed, disclosing circular erosions. Focal areas of severe scale and crusting and partial alopecia were present at the junction of the pelage and mane, causing loss of the mane (Fig 1A, B). Differential diagnoses for the dermatitis included sebaceous adenitis, discoid lupus erythematosus, and sarcoidosis. Differential diagnoses for the nonseasonal urticaria included exercise-induced cholinergic urticaria (CU), as well as heat, stress-induced, or idiopathic urticaria.Initial diagnostic tests consisted of a complete blood count (CBC), serum biochemical profile, cutaneous surface cytology, superficial and deep skin scrapings, a tissue punch biopsy for fungal and bacterial cultures, and seven 6-8 mm skin punch biopsy specimens from multiple affected sites for histopathology. All tests were performed in a routine manner.1 Impression smear cytology from an erosive lesion on the dorsolumbar trunk showed many neutrophils, occasional red blood cells (RBCs) and rare extracellular cocci per oil immersion field. All superficial and deep skin scrapings were negative for parasites. All CBC and serum biochemical results were within normal limits. Bacterial and fungal tissue cultures were negative for growth of organisms. Histopathology from an alopecic and crusted lesion identified hyperplastic crusting, suppurative ly...