Practice 10-Minute Consultation

A scaly rash on the hands

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2252 (Published 28 March 2012) Cite this as: BMJ 2012;344:e2252
  1. H Reddy, specialist registrar1,
  2. A De Vittoris, general practitioner with specialist interest in dermatology2,
  3. S Wahie, consultant dermatologist2
  1. 1Department of Dermatology, James Cook University Hospital, Middlesbrough, UK
  2. 2Department of Dermatology, University Hospital of North Durham, Durham, UK
  1. Correspondence to: H Reddy hari.reddy{at}nhs.net
  • Accepted 20 January 2012

A 30 year old mechanic attends with a scaly rash on both his palms. He describes cuts on his skin which are painful and affect his grip strength. This has caused him to have time off work.

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 …

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