Marc, 43 years old, “Hands in the air”

It was dyshidrotic eczema.

Let’s rule out differential diagnoses:

• Palmar psoriasis:

A personal or family history of psoriasis may help determine the diagnosis. The palmar lesions may also take on a pustular appearance. There is some overlap between palmar psoriasis and chronic hand eczema, both of which are treated with high potency topical corticosteroids and respond to retinoids and methotrexate.

• Contact eczema:

Contact eczema is highly erythematous and very well defined, with a clear edge. The allergen may be occupational or be present during certain leisure activities.

• Dermatophytosis:

Tinea manuum lesions affecting the hand will usually develop as “two feet-one hand” syndrome. This may be revealed by simple palmar hyperkeratosis. When the lesions are erythematous, there is healing of the centre of the lesion with a pustular active edge.

It was dyshidrotic eczema.

Let’s rule out differential diagnoses:

• Palmar psoriasis:

A personal or family history of psoriasis may help determine the diagnosis. The palmar lesions may also take on a pustular appearance. There is some overlap between palmar psoriasis and chronic hand eczema, both of which are treated with high potency topical corticosteroids and respond to retinoids and methotrexate.

• Contact eczema:

Contact eczema is highly erythematous and very well defined, with a clear edge. The allergen may be occupational or be present during certain leisure activities.

• Dermatophytosis:

Tinea manuum lesions affecting the hand will usually develop as “two feet-one hand” syndrome. This may be revealed by simple palmar hyperkeratosis. When the lesions are erythematous, there is healing of the centre of the lesion with a pustular active edge.

It is indeed dyshidrotic eczema.

Let’s rule out differential diagnoses:

• Palmar psoriasis:

A personal or family history of psoriasis may help determine the diagnosis. The palmar lesions may also take on a pustular appearance. There is some overlap between palmar psoriasis and chronic hand eczema, both of which are treated with high potency topical corticosteroids and respond to retinoids and methotrexate.

• Contact eczema:

Contact eczema is highly erythematous and very well defined, with a clear edge. The allergen may be occupational or be present during certain leisure activities.

• Dermatophytosis:

Tinea manuum lesions affecting the hand will usually develop as “two feet-one hand” syndrome. This may be revealed by simple palmar hyperkeratosis. When the lesions are erythematous, there is healing of the centre of the lesion with a pustular active edge.

It was dyshidrotic eczema.

Let’s rule out differential diagnoses:

• Palmar psoriasis:

A personal or family history of psoriasis may help determine the diagnosis. The palmar lesions may also take on a pustular appearance. There is some overlap between palmar psoriasis and chronic hand eczema, both of which are treated with high potency topical corticosteroids and respond to retinoids and methotrexate.

• Contact eczema:

Contact eczema is highly erythematous and very well defined, with a clear edge. The allergen may be occupational or be present during certain leisure activities.

• Dermatophytosis:

Tinea manuum lesions affecting the hand will usually develop as “two feet-one hand” syndrome. This may be revealed by simple palmar hyperkeratosis. When the lesions are erythematous, there is healing of the centre of the lesion with a pustular active edge.