What clue points to the cause of this pruritic rash?

November 10, 2010

Eczema is confined to the dorsum of a 37-year-oldwoman’s hands. She had been applying an over-thecounter,topical antifungal cream but noted no changein the rash. The patient is a hairdresser and enjoyskickboxing.

Eczema is confined to the dorsum of a 37-year-old woman's hands. She had been applying an over-the-counter, topical antifungal cream but noted no change in the rash. The patient is a hairdresser and enjoys kickboxing.

What is your course of action?

A. Perform a potassium hydroxide evaluation.

B. Prescribe a topical corticosteroid cream.

C. Advise the patient to wear gloves when washing, dyeing, or styling hair.

D. Perform a patch test for allergens in the workplace.

E. Advise the patient to give up kickboxing.

(Answer on next page.)

Case 1: Irritant dermatitis

Irritation from the patient's kick-boxing gloves produced an irritant dermatitis on the dorsum of her hands. The eruption's location was a clue to the diagnosis; a contact dermatitis generally affects the fingers and palmar surface.

The kickboxer was advised to purchase new, softer-lined gloves and to use a heavier moisturizer before donning them. A topical corticosteroid cream was recommended for use on an as-needed basis, B. These measures eliminated the problem.