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Index finger plaque

A 27-year-old woman with a history of eczema presented to a local urgent care clinic with multiple small blisters on her right index finger that coalesced into a single plaque over the course of 1 week. She was told she had warts and was advised to use an over-the-counter topical salicylic acid product. She requested a second opinion and sent photos to the Family Medicine Skin Clinic for review. She denied any new exposure to topical chemicals and said she hadn’t had any environmental exposures.

What’s your diagnosis?



Small blisters on finger

The characteristic finding of small, scattered vesicular lesions on the hands that sometimes coalesce, and often are itchy or irritated led to the diagnosis of vesicular hand dermatitis, a form of eczema. It also is referred to as dyshidrotic eczema or pompholyx. (Worth noting is the fact that common warts and flat warts usually present as raised papular—not vesicular—lesions on the hands.)

The exact etiology of vesicular hand dermatitis is unknown. It is more common in women than men and often occurs in patients 20 to 40 years of age who tend to have a positive family history of eczema. It usually develops acutely and often is triggered by topical irritants or frequent hand washing. Treatment during the acute phase includes topical steroids. Avoidance of topical irritants, use of mild cleansers instead of harsh soaps, reduction of hand washing frequency (if possible), and frequent application of emollients can reduce recurrence.

This patient’s eczema had been successfully treated with betamethasone dipropionate ointment 0.05% in the past. Since she still had some at home, she was instructed to use it twice daily along with topical emmolients. She reported great improvement within 1 week.

Photo and text courtesy of Daniel Stulberg, MD, FAAFP, Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque.

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