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Pruritic, lightly-scaled patches on wrists

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A rash first appeared on this patient’s left wrist and then spread to his right. Was his chrome-colored watch to blame—or was there a different cause?


 

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A 19-year-old man presented to our clinic with erythematous, pruritic, lightly-scaled, and annular patches on his dorsal wrists. The rash had first appeared 3 weeks earlier on the patient’s left wrist, which is where he’d been wearing a chrome-colored watch for a couple of years. After the rash appeared on his left wrist, the patient began wearing the watch on his right wrist. Soon after the switch, the rash appeared on his right wrist. The patient was otherwise healthy and denied any previous rashes, had no body piercings or allergies of any kind, and was not on any medications.

On physical exam, we noted 2 erythematous, scaly, annular, and slightly raised plaques on the distal dorsal aspects of both forearms/wrists with a few erythematous papular lesions (FIGURE). There was also scaling on the soles of the patient’s feet and white, moist scaling in the web space between his 4th and 5th toes bilaterally.

Bilateral, erythematous plaques on both wrists image COURTESY OF STEPHEN E. HELMS, MD, FAAD

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

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