Photo Rounds

Chronic blistering rash on hands

Author and Disclosure Information

The location of the patient’s lesions and multiple risk factors suggested that an uncommon disorder was at work.


 

References

A 60-year-old man presented to our dermatology clinic with a chronic, recurrent pruritic rash on his hands and neck. He noted that the rash developed into blisters, which he would pick until they scabbed over. The rash only manifested on sun-exposed areas.

The patient did not take any medications. He admitted to drinking alcohol (4 beers/d on average) and had roughly a 50-pack year history of smoking. There was no family history of similar symptoms.

On physical exam, we noted erosions and ulcerations with hemorrhagic crust on the dorsal aspect of his hands, along with milia on the knuckle pads (FIGURE 1A). Further skin examination revealed hypopigmented scars on his shoulders and lower extremities bilaterally, with hypertrichosis of the cheeks (FIGURE 1B).

Erosions and ulcerations with hemorrhagic crust on the dorsum of hands and milia on knuckle pads

WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU TREAT THIS PATIENT?

Pages

Recommended Reading

Skin changes on abdomen
MDedge Family Medicine
Once-daily oral JAK inhibitor for atopic dermatitis effective in phase 3 study
MDedge Family Medicine
Adjunctive therapy is among the roles for topical agents in psoriasis
MDedge Family Medicine
New mechanisms, therapies for acne considered
MDedge Family Medicine
FDA approves minocycline foam for moderate, severe acne
MDedge Family Medicine
No tacrolimus/cancer link in atopic dermatitis in 10-year study
MDedge Family Medicine
Psoriasis risk rises with TNF inhibitor use in children with inflammatory disorders
MDedge Family Medicine
Dark patches around the trunk
MDedge Family Medicine
Severe psoriasis associated with increased cancer risk, mortality
MDedge Family Medicine
Red patches and thin plaques on feet
MDedge Family Medicine