title: Dermatitis artefacta?
abstract: A 35-year-old man presented with a 2-month history of intensely pruritic excoriated and crusted linear lesions on the dorsa of the left hand and left forearm (Fig 1). The patient had worked in construction for 2 years, and his job consisted mainly in covering the facades of buildings with cement. The patient was right-handed and used a black rubber glove as a protective measure only on his left hand (Fig 2). He reported that the lesions resolved partially during holidays and weekends and clearly flared in association with his work. There was no history of atopic dermatitis, drug use, or intolerance to metals, rubber, or fruits. On physical examination, linear excoriations with crusts were observed on the dorsa of the left hand, extending to the ventral and dorsal aspects of the forearm, involving the whole area that was in contact with the glove. Lichenified erythematous plaques and excoriations on the dorsal surface of the metacarpophalangeal joints and scaly lesions on the dorsal surfaces of the fingers were also present. On the palm, only discrete hyperkeratosis was seen. The right hand and forearm were free of lesions. He complained of intense pruritus when wearing the rubber glove and admitted to continuous scratching to relieve his discomfort, inducing the linear and excoriated lesions. Treatment with topical corticosteroids was initiated, with progressive resolution of the lesions.
authors.affiliation: Servicio de Dermatología Laboral, Escuela Nacional de Medicina y Seguridad del Trabajo, and the Servicio de Inmunología, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Conde-Salazar
authors.forename: Ruud
authors.initials: R
authors.lastname: Valks
authors.forename: María Antonia
authors.initials: MA
authors.lastname: Pastor
authors.forename: María Elena
authors.initials: ME
authors.lastname: Gatica
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Núñez
authors.forename: Berta
authors.initials: B
authors.lastname: Perez Tato
authors.forename: Clara
authors.initials: C
authors.lastname: Iglesias
authors.forename: Manuela
authors.initials: M
authors.lastname: Cuevas
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects*; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D009783:Dermatitis, Occupational / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D003937:Diagnosis, Differential; D017575:Gloves, Protective / Q000009:adverse effects; D006229:Hand Dermatoses / Q000139:chemically induced / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007840:Latex / Q000009:adverse effects*; D008297:Male; D010328:Patch Tests
chemical_list: D000485:Allergens; D007840:Latex