Photo Rounds

Stubborn hand rash

Michael L. Crandall, MD
Flight Surgeon, US Navy, Camp Pendleton, Calif

Richard P. Usatine, MD
University of Texas, Health Science Center at San Antonio

The author reported no potential conflict of interest relevant to this article.

The views expressed herein are those of the author and do not reflect the official policy of the US Navy, Department of Defense, or the US government.

Was there a connection between the rash on this patient’s hand and another condition he occasionally suffered from?


A 24-YEAR-OLD MAN sought care at our primary care clinic for a stubborn rash that had come on gradually and grown to cover much of his left hand. The rash itched and after much scratching, it began to crack and enlarge. The patient denied any trauma to the hand, but said that the rash was now mildly painful.

The patient indicated that he’d applied a topical antifungal agent to his hand and that the lesion initially shrunk. However, after he stopped using the cream, the rash flared again. He denied any similar lesions on his body, but did note that he occasionally suffered from athlete’s foot. The patient said that he did not wear any rings or gloves regularly. He also denied excessive hand washing.

On examination, I noted a well-circumscribed, dry, flaky, erythematous plaque that extended to the base of each of his 4 fingers (FIGURE 1A). One of the extensions continued to the dorsal side of the middle finger; this area was raised, scaly, and had a scab (FIGURE 1B). The webbing of the fingers was also involved, but the nails were spared.

Pruritic rash extends to the dorsal side of the middle finger