What Is the Cause of This Woman’s Hand Rash?
David L. Kaplan, MD—Series Editor
Kaplan DL. What is the cause of this woman’s hand rash? Consultant. 2016;56(10):906-907.
This 51-year-old woman presented with a 1-year history of an itchy, tender rash in the webs and on the palms of both hands that had appeared on and off. She was not aware of any exacerbating causes. She was otherwise healthy and denied any new exposure history.
What is the cause of this woman’s hand rash?
- Contact dermatitis
Answer and discussion on next page
A biopsy confirmed the diagnosis of eczema, which most likely was brought on by a combination of factors, including underlying atopic dermatitis (as manifested by her hyperlinear palms) and a loss of hormonal protection due to menopause, as well as the natural aging process that makes skin less forgiving to excessive washing of hands.
She was educated about a new hand-washing regimen with nondrying soaps and more frequent moisturizing, as well as prescribed a midpotency topical corticosteroid cream for flares.
Contact dermatitis is not an unreasonable suspicion, and patch testing for resistant cases should be entertained. Psoriasis typically would have better-demarcated patches than what is seen here, as well as possible patches elsewhere and nail pitting. Candidiasis would not be expected in a healthy individual, occurring more commonly in a person with diabetes, for instance. Dyshidrosis is a type of hand eczema manifested by pruritic vesicular lesions on the sides of the fingers and palms, unlike what is seen here.
David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.