A 43 year old female presents to the clinic with the followi | Figure 1

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Case Summary

A 43 year old female presents to the clinic with the following examination finding. The patient states that for the past few years she notices this rash that occurs on the dorsum of her hands and can extend up to her elbows. She describes the rash as pruitic at times and also states that the rash burns most of the time. She has noticed that the rash occurs mainly during the spring, will last for one week then regress. She states some association of the rash with humidity. Patient denies allergies, denies joint or muscle pains and does not take any daily medicine. She has tried steroid creme in the past but reports it did not work and she stopped using it after one application. Patient denies any new lotion, gardening, new laundry detergent, new soaps or shampoo. FDLMP was 2 weeks ago. On physical exam, a vesicular rash that is concentrated on the hands with sparse vesicles noted on the antebrachium is seen.

Past medical history includes inactive hepatitis C.