| Inflammatory |
| Irritant contact dermatitis | Common F > M Any age Atopics are at increased risk | Pruritic, burning, or painful Variable onset depends on frequency of exposure and strength of irritant | Well-demarcated with a "glazed" appearance Erythema, fissures, blistering, and scaling usually in finger web spaces or dorsum of hands (Figures 8-1, 8-2, 8-3) |
| Allergic contact dermatitis | Common F > M Any age | Pruritic with onset hours to days after contact with allergen | Acute: papules and vesicles on an erythematous base (Figures 8-4 and 8-5) Chronic: xerosis, fissuring, hyperpigmentation, and lichenification usually on the dorsum of hand and distal fingers (Figures 8-1, 8-2, 8-3) |
| Atopic dermatitis | Common F > M Age: any May be only manifestation of disease in adults | Pruritic and sometimes painful Chronic course with exacerbations Triggers: frequent hand washing or wet work Usually worse in winter Family history of atopy | Presents with swelling, xerosis, fissuring, erythema, and lichenification on dorsum and palms (Figure 2-10) |
| Dyshidrotic dermatitis | Common F ≥ M Age: young adults and atopics overrepresented | Very pruritic Chronic and recurrent, episodes last 2-3 weeks. Exacerbated by sweat and stress | Multiple grouped vesicles and erosions on noninflammatory base on lateral surface and palms (Figure 8-12) |
| Psoriasis vulgaris | Common M = F Age of onset: peaks in 20s and 50s. May be only manifestation of disease | Painful fissures or pruritic Chronic indolent course May have arthritis and family history of psoriasis | Presents with well-demarcated erythematous plaques with loosely adherent, silvery scale (Figure 9-1), or less commonly with pustules on central palms (Figure 9-6) |
| Palmoplantar pustulosis | Uncommon F > M Onset: 50-60 years of age | Pruritus, burning, pain Lasts years Waxing and waning course | Scattered creamy yellow pustules and dusky red macules on palms |
| Lichen planus | Uncommon F > M Age: 30-60 years | Asymptomatic or pruritic Lasts months to years May be drug-induced or associated with hepatitis C infection | Classically, flat-topped, well-defined, polygonal, violaceous, shiny papules on volar wrist and dorsum (Figure 9-10) |
| Infectious |
| Warts | Common M > F More common in children and young adults | Asymptomatic or painful. May persist for years | Discrete or confluent hyperkeratotic papules or plaques. May have black or brown dots within the lesions created by thrombosed capillaries (Figure 11-6) |
| Tinea manuum | Uncommon M > F | Asymptomatic or pruritic. Last months to years Contact with infected person or animal or autoinoculation (eg, from foot or groin) Usually associated with tinea pedis | On palms presents with diffuse fine scaling (Figure 10-6). Unilateral in 50%. On dorsum presents with annular red patch/plaque with peripheral scale at leading edge. Nails may be affected |
| Herpetic whitlow | Uncommon At risk: Healthcare workers, or contact with HSV | Painful | Grouped and confluent vesicles on red edematous base on a distal digit |
| Neoplastic |
| Actinic keratoses | Common M > F Age: >40 years | Asymptomatic or tender Duration: months to years Risk factors: advancing age, cumulative sun exposure, outdoor occupation, and fair skin type | Skin-colored, yellow-brown, pink ill-defined gritty papules with adherent hyperkeratotic scale (Figure 17-1) |
| Systemic disease |
| Acute cutaneous lupus erythematosus (generalized) | Uncommon F > M Age: any age, but most commonly 30-40 years of age High morbidity | Pruritus or burning Duration: weeks to months Maybe related to sun exposure. Associated with fevers, fatigue, oral ulcers, and other systemic findings consistent with SLE | Red clustered papules, urticarial plaques, and patchy erythema with variable scale on dorsal hands, classically sparing the skin overlying the joints |
| Dermatomyositis | Uncommon F > M Age: bimodal; peaks at ages 5 to 10 and 50 years | Asymptomatic or mildly pruritic. Chronic course Associated with photosensitivity, scalp pruritus/burning, and symmetric proximal muscle weakness | Flat-topped violaceous papules overlying knuckles and interphalangeal joints (Gottron's papules) Periungual erythema (Figure 24-6) |
| Porphyria cutanea tarda | Uncommon M = F Age: adults 30-50. Hereditary or acquired (eg, medications) | Pain from erosions Gradual onset easily traumatized fragile skin Implicated drugs: ethanol, estrogen, iron, among others Other predisposing factors: diabetes mellitus and hepatitis C virus | Tense vesicles/bullae and erosions with normal appearing surrounding skin Atrophic white-pink scars and milia on dorsal hands (Figure 24-13) |
| Photodermatoses: see Chapter 31 (Skin Diseases of the Face) |