Hand Dermatitis

Clinical Case

Case 1

  • 44-year-old healthy male
  • No significant past medical history
  • Review of systems is noncontributory
  • Job history notable for work at a printing press
  • No hobbies with chemical exposures
  • Presents for management of 18 months history of a hyperkeratotic eruption on bilateral palms; the feet are not affected
  • Currently using topical triamcinolone 0.1% ointment daily and emollient lotion with partial benefit

Initial evaluation

  • Healthy appearing male
  • Bilateral hands with hyperkeratotic erythematous plaques with fissures present at the fingertips
  • Diagnosis: hand dermatitis
  • Recommend patch testing
  • Soaks in tap water for 10 minutes twice daily followed by application of clobetasol 0.05% ointment
  • Gentle skin care recommended: use of gentle hand soaps, frequent use of lipid-rich emollients, avoidance of wet work (such as dishwashing and other housework) without gloves
  • Follow-up in 2 weeks

Two-week follow-up evaluation

  • Partial improvement
  • Patch testing (including for chemicals involved in printing process) does not reveal any clear triggers
  • Recommend ongoing twice daily soaks and clobetasol ointment
  • Follow-up in 2 weeks

Follow-up evaluation

  • Minimal interval improvement
  • Recommend limited use of clobetasol ointment (use three days a week) alternating with 20% LCD tar in petrolatum
  • Follow-up in 6 weeks (still not resolved -> soak PUVA is initiated)