Careers  |  Sign In  |  Register  |   Twitter

51-Year-Old Female with Hand Eczema

Can you diagnose this case?

David L. Kaplan, MD-Series Editor

Signs and Symptoms

This 51-year-old woman presented with a 2-year history of chronic hand eczema that would partially respond to topical corticosteroids, only to recur. She denied any new exposure history. She had not had the condition in the past.

What explains this recurrent rash?

Choose one to reveal diagnosis and discussion

Contact dermatitis
Atopic dermatitis
Psoriasis
Lichen planus
Dyshidrosis

Answer: Psoriasis

See the full case at Consultant360

The patient had psoriasis, which originally had been diagnosed and treated as eczema.

Note: All of the approaches listed above—patch testing, KOH prep testing, and examination of the fingernails, elbows, knees, and feet—are important maneuvers in making the correct diagnosis of psoriasis. The fingernails will show possible signs of psoriasis or lichen planus. Tinea pedis of the feet could result in dyshidrosis and yield KOH prep test results that are positive for fungal infection.

On closer physical examination, this patient also had involvement of her elbows, which allowed the diagnosis of psoriasis to be made. The well-demarcated lesions on the palms support the diagnosis. Nevertheless, it is important to remember that patients can have overlapping diagnoses.

While topical treatment is the safest option for psoriasis, patients with extensive involvement often require systemic therapy. This is especially true for difficult-to-treat areas such as the hands. This patient was started on topical corticosteroids alternating with calcipotriene.

More Cases
45-Year-Old Female with Asymptomatic Solitary Papule

Can you identify this skin ailment? Take this week's Derm Case Challenge to validate your diagnosis.

45-Year-Old Female with Asymptomatic Solitary Papule
38-Year-Old Male with Left Thumb Lesion

Derm Case Challenge

38-Year-Old Male with Left Thumb Lesion
75-Year-Old Female with Rash on Lower Extremities

Test your dermatology knowledge with this week's Derm Case Challenge.

75-Year-Old Female with Rash on Lower Extremities
40-Year-Old Male with Growing Lesion on Back

Can you identify this skin ailment? Take this week's Derm Case Challenge to validate your diagnosis.

40-Year-Old Male with Growing Lesion on Back
45-Year-Old Male with Photodistributed Rash

Derm Case Challenge

45-Year-Old Male with Photodistributed Rash
46-Year-Old Female with Knee and Lower Back Aches

Derm Case Challenge

46-Year-Old Female with Knee and Lower Back Aches
75-Year-Old Female with Rash on Lower Extremities

Test your dermatology knowledge with this week's Derm Case Challenge.

75-Year-Old Female with Rash on Lower Extremities
40-Year-Old Female with Inframammary Rash

Derm Case Challenge

40-Year-Old Female with Inframammary Rash
42-Year-Old Male with Abnormal-Looking Thumbnails

Test your dermatology knowledge with this week's Derm Case Challenge.

42-Year-Old Male with Abnormal-Looking Thumbnails
27-Year-Old Male with Bumps on Scalp and Neck

Derm Case Challenge

27-Year-Old Male with Bumps on Scalp and Neck