Chronic eczema on hands
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William D. James, MD, Professor, Department of Dermatology, University of Pennsylvania, Philadelphia.

Disclosure: William D. James, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Elsevier.

Question 1 of 3

A 40-year-old woman presents because of incessantly pruritic, diffuse dermatitis mainly affecting her head, face, and neck, as well as chronic eczema on her hands for the past 6 months. She reports that it flares unexpectedly, then goes into somewhat of a remission, but it does not resolve completely despite use of Aquaphor and a topical cortisone ointment. Physical exam reveals xerosis and multiple areas of lichenification, as well as eczematous lesions on her hands and nodular prurigo on her shoulders. All regions of her body are affected to some extent, and she appears pale. Her SCORAD value is > 50.

The patient has a history of seasonal allergies (allergic rhinitis), with sensitivity to deciduous tree pollens and ragweed. She has successfully managed this with over-the-counter antihistamines, decongestants, and an intranasal steroid spray. Otherwise, her medical history is unremarkable. The patient reports no food allergies.

Laboratory testing reveals elevated immunoglobulin (IgE) levels and eosinophilia. Lactate dehydrogenase and anti-transglutaminase antibody levels are normal.

What is the likely diagnosis?


Allergic contact dermatitis

Severe atopic dermatitis

Cutaneous T-cell lymphoma

This quiz is not accredited for CME.

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