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Erythematous patches on the hands

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Our patient’s history of obsessive-compulsive disorder may have masked the true diagnosis for years.


 

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A 49-year-old Caucasian man sought care at our clinic for erythematous patches on the dorsal surface of his hands. The patient indicated that these lesions had appeared approximately 2 to 3 years earlier and that they had become increasingly painful when exposed to sunlight. The patient’s mother also recalled multiple sunburns that he’d suffered in the past.

The patient had a mild mental impairment and struggled with obsessive-compulsive disorder. He admitted to washing his hands 10 to 15 times a day, and was previously given a diagnosis of dyshidrosis secondary to excessive hand washing. The patient was treated with moisturizing creams, but his symptoms did not improve.

Examination of the dorsal surface of his hands revealed multiple erythematous patches, blisters, and calluses, as well as ulcerations on the proximal and distal interphalangeal joints (FIGURE 1). There were also scarred and linear plaques on the bilateral proximal and distal interphalangeal joints. The patient had no other lesions on his body.

FIGURE 1
Erythematous patches, blisters, calluses, and ulcerations

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

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