Acute Bilateral Hand Dermatitis in Young Adult
Case at a Glance
A 21-year-old female presented with acute onset of pruritic papulovesicular eruption on bilateral hands, predominantly affecting the dorsal surface of the left hand, with potential occupational or contact sensitization triggers.
Patient's Story
The patient reported the sudden appearance of numerous small, white-to-erythematous papules on the dorsal aspect of her left hand approximately 24 hours prior to presentation. The lesions were described as intensely pruritic and appeared in clusters. Similar but fewer lesions were noted on the right hand. The patient had a recent history of frequent hand sanitizer use over the preceding week, which had resulted in noticeable skin dryness. She also recalled using latex gloves several days before symptom onset during work activities.
Initial Assessment
Physical examination revealed multiple small, discrete papulovesicular lesions distributed across the dorsal surface of both hands, with left-sided predominance. The lesions appeared inflammatory with surrounding erythema. The patient had already attempted self-treatment with oral antihistamines without significant improvement in symptoms.
The Diagnostic Journey
The clinical presentation suggested contact dermatitis as the primary differential diagnosis. Given the temporal relationship with both increased sanitizer use and latex glove exposure, both irritant contact dermatitis from chemical irritation and allergic contact dermatitis from latex sensitivity were considered. The bilateral distribution and recent occupational exposures supported an external trigger rather than an internal systemic cause.
Final Diagnosis
Contact dermatitis of bilateral hands, likely multifactorial etiology involving both irritant dermatitis from frequent sanitizer use and possible allergic contact dermatitis from latex exposure.
Treatment Plan
Conservative management was recommended including topical hydrocortisone 1% cream applied twice daily to affected areas, frequent application of fragrance-free moisturizers to restore skin barrier function, and avoidance of known triggers including latex gloves and excessive hand sanitizer use. Patient education was provided regarding proper hand hygiene techniques and the use of powder-free nitrile gloves as an alternative to latex.
Outcome and Follow-up
Patient was advised to continue treatment for two weeks with clinical reassessment if symptoms persisted or worsened. Patch testing for latex allergy was recommended if symptoms recurred with future latex exposure. The patient was counseled on the importance of identifying and avoiding trigger substances to prevent future episodes.