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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
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
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
CE Dermatology Clinic
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