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54-Year-Old Female with Chronic Dermatitis on Hand

Can you diagnose this case?

David Kaplan, MD – Series Editor – 2016

Signs and Symptoms

This 54-year-old woman presented for evaluation of chronic dermatitis on her hand that had appeared on and off for several years. She could never identify factors that either exacerbated or ameliorated the condition. She was otherwise healthy, and denied rashes elsewhere.

What could be responsible for this woman’s hand rash?

Choose one to reveal diagnosis and discussion

Psoriasis
Eczema
Contact dermatitis
Id reaction or hypersensitivity reaction
Tinea manuum

Answer:Eczema

See the full case at Consultant360

When the KOH examination was negative and an examination of the feet did not reveal evidence of fungal infection, a biopsy was performed, the results of which confirmed the diagnosis of eczema or atopic dermatitis. This patient may have had a late onset of her hand dermatitis brought on by the loss of hormones associated with menopause in recent years, as well as the natural aging process, which makes the skin less-forgiving to the same hand-washing regimen. The clinical clue in this case was the hyperlinearity of the palms, supporting the clinical and histopathologic diagnosis. If a rash such as this woman’s does not clear readily or easily, doing patch testing would appropriate.