Picture of the Month Quiz
A 4-year-old boy born in Jamaica presented to the emergency
department with a 2-year history of intermittent "rash." His
mother described red scaly patches affecting only the palms of
his hands and the soles of his feet, and he was brought in for
evaluation secondary to an acute increase in itching and pain.
The patient had been scratching the lesions to the point of skin
breakdown, and he had been less inclined to bear weight on his
feet secondary to pain. The family had been using topical
over-the-counter hydrocortisone acetate cream and oral
antihistamines without significant effect. They noted periods
when the skin lesions improved but no period of true skin
clearing over the past 2 years. He had no recent fevers, weight
loss, joint pain, dental issues, or mucous membrane lesions.
There was no family history of any dermatologic condition.
Results of his physical examination revealed diffuse erythema
with scaly yellow-brown plaques on the volar aspects of the hands
and the plantar aspects of the feet (Figures 1and
2). There were areas of fissuring with minimal
bleeding. The remainder of the cutaneous examination was
remarkable only for a small white scaly patch on his chest and
for his having dystrophic fingernails and toenails with some
evidence of pitting. His hair and teeth were normal.
For a complete discussion of this month's case, read the
Picture of the Month—Quiz Case.