Distinguish between hand eczema and palmar psoriasis

Description

Case Report
Introduction: Dermatological conditions affecting hands are common and disabling disorders with strong impact on the quality-of-life, social activities and occupational performance. Clinical manifestations of hand eczema show similarities to a broad spectrum of dermatoses that should be considered, including palmar psoriasis. Distinguishing between these two common conditions may be challenging especially in initial phase and misdiagnosis can lead to inadequate treatment. [Thyssen et al., 2022].



Case presentation: 54-year-old female patient visited dermatologist complaining of palmar redness, mild pruritus, and painful fissures for more than 2months. The first similar episode of hand dermatosis was reported two years ago and histological examination of punch biopsy specimen from palmar skin showed subacute, spongiotic dermatitis with Langerhans cells microabscesses. Diagnosis of contact dermatitis was made. Patient received treatment with moderate potency topical corticosteroids and emollients. Disease exacerbates during winter and spring period.

Occupation: office worker. Allergies: pollen. Other diseases or chronic conditions denies.

Two years later- at present due to recurrent dermatitis, another punch biopsy from palmar skin was performed and histological examination demonstrated features of psoriasis – thick epidermal hyperkeratosis, focal parakeratosis, Munro microabscesses, acanthosis, absent granular layer, basal mitoses and focal spongiosis. Blood tests showed slightly elevated IgE (122 IU/mL) levels. Skin colonization with Staphylococcus aureus was found. Fungal culture test was negative.

Topical therapy was continued, patient was reluctant to start systemic therapy with methotrexate.

Conclusion/discussion: Detecting the correct diagnosis can be challenging in case of isolated palmar dermatosis due to similar appearance and clinical findings. Case report shows the parallels and difficulties to distinguish between hand eczema and psoriasis. Even precisely collected anamnesis and laboratory examination may not give a clear clue on correct diagnosis. Further studies and finding potential biomarkers might be essential to clarify diagnosis. Non-invasive investigative techniques would be desirable.

Period	24 Mar 2023
Event title	EAACI-ESCD Skin allergy meeting
Event type	Meeting
Degree of Recognition	International