A scaly rash on the hands

What issues you should cover

Common causes of diffuse scaly rashes on the hands are eczema (atopic, irritant or allergic contact dermatitis, and pompholyx), psoriasis, scabies, and tinea. A patient can have more than one diagnosis (such as atopic eczema plus an occupational allergic contact dermatitis).

To help identify the cause(s) and effects of the rash, inquire about

• Duration and evolution of disease

• Presence of itch or rash elsewhere

• Personal or family history of atopy (eczema, asthma, or hay fever) or psoriasis

• Occupation and hobbies, and the impact of the rash on these

• Suspected triggers and a review of work practices—particularly relevant for allergic and irritant contact dermatitis. Ascertain

  • What does the patient come into contact with at work? What is the duration from exposure to a suspected trigger to the rash flaring? Does the rash improve if the suspected trigger is removed or when the patient is off work? What is the frequency of hand washing?

• Contacts with symptoms—relevant for scabies, although asymptomatic contacts do not exclude scabies in …