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Exposure to moisture leads to palmar rash by ProQuest


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    CME Dermatology Clinic
     CE                                ■ LEARNING OBJECTIVES: To increase awareness of dermatologic conditions, their
                                         diagnosis, and up-to-date treatment.
                                       ■ COMPLETE THE POSTTEST: Page 57        ■ ADDITIONAL CME/CE: Pages 21, 53

  CASE #1

Exposure to moisture
leads to palmar rash
A 24-year-old woman presented with a six-year history of a recurring,
somewhat painful and pruritic palmar rash. The rash developed on either
hand within minutes of exposure to water or sweating and disappeared
after about an hour of drying. She arrived at the office with a bucket
of water in which to submerge her hand to demonstrate the problem.
Her medical history was otherwise unremarkable. Physical exam of
the sodden hand revealed confluent, edematous, hypopigmented-to-
translucent papules with visibly prominent ductal openings.

What is your diagnosis? Turn to page 40

                                                          CASE #2

                                                       Tender, edematous, red
                                                       plaques on a woman’s
                                                       hands and feet
                                                       JENNIFER STEAD, DO, AND STUART GILDENBERG, MD
                                                       A 67-year-old woman presented with painful hands and feet with
                                                       intense redness and peeling skin. The patient had a medical history of
                                                       transitional-cell bladder cancer. Treatment with the chemotherapeutic
                                                       drug capecitabine had begun one month prior to our consultation.
                                                       Exam revealed symmetric, well-demarcated erythematous plaques
                                                       with edema over the distal finger pads of all 10 digits. Intense ery-
                                                       thema, edema, and palpable warmth were observed on all 10 distal
                                                       toe pads. Tactile sensations were intact.

                                                       What is your diagnosis? Turn to page 41

                                              • THE CLINICAL ADVISOR • AUGUST 2010 39
                                CE           Dermatology Clinic
                    Aquagenic syringeal
  CASE #1                                                          conditions begin at or after puberty; involve acral skin; and
                    acrokeratoderma                                demonstrate a peculiar wrinkled, edematous reaction to water
                               The patient was diagnosed           or sweat exposure. Although the skin findings may be similar,
                               with aquagenic syringeal            there are distinct differences between these two entities.
                               acrokeratoderma, a rare entity        Lesions of aquagenic syringeal acrokeratoderma are tran-
                               in which brief exposure to          sient compared with hereditary papulotranslucent acrokerato-
                               water results in the formation      derma lesions, which are persistent. Most cases of aquagenic
                               of pale or translucent edema-       syringeal acrokeratoderma affect th
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