Picture Quiz: A smoker's hand
BMJ 2005; 330 doi: https://doi.org/10.1136/sbmj.0506227 (Published 01 June 2005) Cite this as: BMJ 2005;330:0506227
- Rameen Shakur, fifth year medical student1,
- Ashraf Khan, fourth year medical student1,
- Mohammed Atcha, third year medical student1,
- Nikhil Hirani, consultant and senior lecturer in respiratory medicine1,
- Faheem Shakur, fourth year medical student2
- 1University of Edinburgh
- 2University of Sheffield
A 64 year old man with a 40 pack year smoking history presented to an outpatient clinic after an acute asthma attack. He had no other relevant medical history. Upon general examination, however, doctors noted abnormalities on his right hand (see figure). He described a loss of sensation confined to this area that had lasted for 10 years. But, for the past couple of years, this area of his hand had become dry and itchy. The man was a painter-decorator. He said that he did not always wear gloves when decorating and that he used white spirit to remove paint.
Questions
Describe the abnormality seen in the picture.
What are the differential diagnoses?
What aspects of the patient's history are important?
Answers
There is an area of erythema (redness) running mid-way up the dorsal (back) surface of the middle finger of the right hand.
Differential diagnoses:
Burns - thermal, chemical, sunburn
Irritant dermatitis - unlikely, the history would contain information of prolonged exposure to an antigen
Psoriasis - unlikely, doesn't have classical features of psoriasis (dry, silver scales) and has an abnormal distribution (psoriasis usually affects extensor surfaces)
Cellulites - unlikely, area is usually swollen and commonly follows …
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