Erythematous patches on the hands

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Erythematous patches on the hands

J Fam Pract. 2012 February;61(2):101-104

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References

1. Michaels BD, Del Rosso JQ, Mobini N, et al. Erythropoietic protoporphyria: a case report and literature review. J Clin Aesthet Dermatol. 2010;3:44-48.

2. Wahlin S, Floderus Y, Stål P, et al. Erythropoietic protoporphyria in Sweden: demographic, clinical, biochemical and genetic characteristics. J Intern Med. 2011;269:278-288.

3. James WD, Berger TG, Elston DM. Errors in metabolism. In: James WD, Berger TG, Elston DM, eds. Andrews’ Diseases of the Skin: Clinical Dermatology. 11th ed. Philadelphia, Pa: Elsevier; 2011:511–515.

4. Murphy GM. Porphyria. In: Bolognia JL, Jorizzo JL, Rapini R, eds. Dermatology. 1st ed. Philadelphia, Pa: Elsevier; 2003:679–686.

5. Herrero C, To-Figueras J, Badenas C, et al. Clinical, biochemical, and genetic study of 11 patients with erythropoietic protoporphyria including one with homozygous disease. Arch Dermatol. 2007;143:1125-1129.

6. Usatine RP, Riojas M. Diagnosis and management of contact dermatitis. Am Fam Physician. 2010;82:249-255.

7. Yeh SW, Ahmed B, Sami N, et al. Blistering disorders: diagnosis and treatment. Dermatol Ther. 2003;16:214-223.

8. Kedrowski DA, Warshaw EM. Hand dermatitis: a review of clinical features, diagnosis, and management. Dermatol Nurs. 2008;20:17-25.

9. Gambichler T, Al-Muhammadi R, Boms S. Immunologically mediated photodermatoses: diagnosis and treatment. Am J Clin Dermatol. 2009;10:169-180.

10. Murphy GM. Diagnosis and management of the erythropoietic porphyrias. Dermatol Ther. 2003;16:57-64.

11. Lecluse AL, Kuck-Koot VC, van Weelden H, et al. Erythropoietic protoporphyria without skin symptoms–you do not always see what they feel. Eur J Pediatr. 2008;167:703-706.

12. Holme SA, Anstey AV, Finlay AY, et al. Erythropoietic protoporphyria in the U.K.: clinical features and effect on quality of life. Br J Dermatol. 2006;155:574-581.

13. Sies C, Florkowski C, George P, et al. Clinical indications for the investigation of porphyria: case examples and evolving laboratory approaches to its diagnosis in New Zealand. NZ Med J. 2005;118:U1658.-

Porphyria cutanea tarda. This most common form of porphyria is characterized by increased sensitivity and fragility of the skin.³ (For more information, see “Genetic blood disorders: Questions you need to ask,” J Fam Pract. 2012;61:30-37.) Vesicles and bullae will form after minimal trauma, typically on the dorsal surface of the hands, extensor surfaces of the forearms, and the face. These lesions will eventually form erosions and heal slowly to form atrophic scars. Excessive hair growth on the face, postinflammatory hyperpigmentation, scarring alopecia, and scleroderma-like changes with yellowish-white plaques have also been described in porphyria cutanea tarda. Wood’s lamp examination of urine will reveal a coral-red fluorescence.^4,7

Dyshidrotic eczema. This disease is characterized by the sudden onset of pruritic, clear vesicles on the fingers, palms, and soles. The vesicles are deep-seated and are typically devoid of surrounding erythema. Each episode will spontaneously regress in 2 to 3 weeks, but this disease can be disabling due to the recurring nature of the outbreaks.^4,8

Solar urticaria. Within minutes of sun exposure, erythematous patches with or without wheals will appear. The lesions typically last less than 24 hours, and are most commonly found on the chest and upper arms. Pruritus and a burning sensation frequently accompany flares of solar urticaria, and pain may be present but is not a common symptom. In severe cases, an anaphylactoid reaction can occur, with light-headedness, nausea, bronchospasm, and syncope.^4,9

Hydroa vacciniforme. Within hours of sun exposure, erythematous macules will appear. They will progress to papules and vesicles, and may become hemorrhagic. These lesions are typically found on the face, ears, and dorsa of the hands in a symmetric, clustered pattern. Pruritus and a stinging sensation may accompany the lesions, as well as general malaise or fever. Over the course of a few days, the lesions will become necrotic, form a hemorrhagic crust, and heal with ”pox-like” vacciniform scars.^4,9

Erythematous patches on the hands

References

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