Photo Rounds

Painful, red hands

A 54-year-old cook asked his family physician (FP) to look at his hands, which had been red and painful for the past 2 months. The patient worked in a restaurant and was constantly handling warm water and utensils. The patient had diabetes that was not well controlled (HbA1c, 9%).

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The FP suspected contact dermatitis, but also noted that the patient had white material between his fingers and performed a potassium hydroxide (KOH) preparation. (See a video on how to perform a KOH preparation here: Under the microscope, the FP found budding yeast and the pseudohyphae of Candida albicans. Candida in the interdigital space is called erosio interdigitalis blastomycetica.

Patients with diabetes are at higher risk for this condition, as are those who perform “wet work.” The FP discussed the importance of hand protection with the patient and ways to better control his diabetes.

Fortunately, the patient had the next 2 days off of work so he was able to begin his treatment while avoiding the irritating environment at work. The FP recommended that the patient purchase over-the-counter clotrimazole cream to apply between his fingers. He also prescribed 0.1% triamcinolone ointment to be applied twice daily and discussed the use of protective gloves with cotton liners whenever possible.

The FP also referred the patient to Dermatology for further evaluation of the suspected contact dermatitis (including patch testing).

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Hand eczema. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:597-602.

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