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Test your clinical acumen with our monthly quiz 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 CAROLINE Y. WINSLOW AND JULIA R. NUNLEY, MD 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 www.clinicaladvisor.com • THE CLINICAL ADVISOR • AUGUST 2010 39 CME 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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