Does amphetamine medication cause this persistent rash?

This 59-year-old female presents with a hand rash a few months duration. She takes relatively high doses of an ampthetamine class medication for a diagnosis of ADHD. She is otherwise healthy.

What do you suspect?

A.Amphetamine induced hand eczema.

B.Psoriasis.

C.Dyshidrosis. 

D.Atopic dermatitis.

E.Contact dermatitis.

(Answer and discussion on next page.)

Answer—Case 1: Psoriasis

Beware of representativeness error, the tendency to attribute a condition due to a negative stereotype. There are no known associations between amphetamines and hand eczema, although there is a possible association with anxiety.

The patient had features of atopy as well, however the well demarcated patches are more indicative of psoriasis (B). The absence of vesicles tends to exclude dyshidrosis. Contact dermatitis would not persist for months and not be as well demarcated.■

David L. Kaplan, Md–Series Editor: Dr Kaplan is clinical assistant professor of dermatology at the University of Missouri Kansas City School of Medicine and at the University of Kansas School of Medicine. He practices adult and pediatric dermatology in Overland Park, Kan.