Hand dermatoses are common in primary care and dermatology, and overlapping clinical features can make diagnosis challenging. Here are some clues for diagnosis.
Chronic hand eczema
- Pruritic, scaly plaques with lichenification
- Fissuring may occur in longstanding disease
- Often involves dorsal hands and fingers as well as wrists
- Personal or family history of atopy may be present
Irritant contact dermatitis on the hand
- Xerosis with erythematous, scaly plaques
- Often involves the dorsal hands and palms as well as finger webs
- History of wet work or frequent hand washing
- High-risk occupations include cleaning, food preparation, health care, and hairdressing
Psoriasis on the hand
- Sharply demarcated erythematous plaques with silvery scale may be seen on the dorsal hands
- Palms may show hyperkeratotic plaques
- Often symmetric
- Nail findings such as pitting, onycholysis, and oil spots support the diagnosis
Distinguishing Features
- Chronic hand eczema: think itch + lichenification + atopic background
- Irritant contact dermatitis: think exposure history + barrier damage
- Psoriasis: think well-demarcated plaques + nail clues
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