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

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

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

A. Psoriasis
B. Eczema
C. Contact dermatitis
D. Id reaction or hypersensitivity reaction
E. Tinea manuum

Bonus question: Despite her denial of rashes elsewhere, where on the skin should one examine for potential clues?

Answer on next page.

Answer: Eczema

When the KOH examination was negative and  an examination of the feet (bonus question answer) 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.