What Would You Say About This Patient’s Hands?

AUTHOR:
David L. Kaplan, MD—Series Editor

CITATION:
Kaplan DL. What would you say about this patient’s hands? Consultant. 2016;56(12):1109-1110.

This 51-year-old woman presented for evaluation of an asymptomatic rash of 2 years’ duration on her hands. She had seen several physicians and had been given an original diagnosis of eczema, then psoriasis, then finally dermatomyositis. She now had come for another opinion.

During the physical examination, the patient was noted to have changes of the skin of her right cheek, adjacent to the nose, which she said had been present for 1 year. She had been told that the lesion was a mole.

What would you say about this patient’s hands?

1. It’s eczema
2. It’s psoriasis
3. It’s dermatomyositis
4. It’s all 3 of the above
5. It’s contact dermatitis

What would be the next step?

1. Prescribe a potent topical corticosteroid for up to 1 month
2. Prescribe tacrolimus or pimecrolimus as a corticosteroid-sparing agent
3. Recommend that she start wearing sunscreen
4. Do a skin biopsy
5. Perform patch testing

Meanwhile, how would you approach her facial lesion?

1. Do a skin biopsy
2. Do nothing but offer reassurance
3. Apply a low-potency corticosteroid cream for 1 to 2 weeks
4. Apply ketoconazole cream, 2%, once a day as needed
5. Apply metronidazole gel once a day as needed

Answers and discussion on next page.

Answer: Biopsy of the hands to confirm eczema; biopsy of the facial lesion

A biopsy of the lesions on the woman’s hands confirmed the clinical impression of eczema. This patient had been washing her hands more often than she had been moisturizing them. She was also perimenopausal and had lost the protection of estrogen, resulting in more dryness, as well. The affected areas were more prone to trauma and rubbing, resulting in the clinical pattern. Changing her washing and moisturizing regimen proved beneficial.

A skin biopsy of the lesion on her right cheek revealed a morpheaform basal cell carcinoma that required excision.

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.