Acute Onset of Vesicular Lesions on Unilateral Hand

Case at a Glance

A 27-year-old female with a history of panic disorder and eczema presented with acute onset of multiple small vesicular lesions arranged in a linear pattern on one hand, discovered after bathing.

Patient's Story

The patient noticed multiple small, round, hole-like lesions on her hand immediately after showering. She described them as appearing suddenly without any preceding symptoms. The lesions were asymptomatic - no pain, pruritus, or burning sensation. She expressed concern about potential contagiousness, particularly regarding contact with her spouse. The patient had recently applied gel nail polish for the first time in over a year. She denied any recent travel, new exposures, or changes in skincare products aside from the nail treatment.

Initial Assessment

Physical examination revealed multiple small vesicular lesions arranged in a linear distribution on the palmar aspect of one hand. The contralateral hand and feet were unaffected. The patient appeared anxious but otherwise well. Vital signs were stable. No lymphadenopathy was detected. The lesions were non-tender and non-pruritic on examination.

The Diagnostic Journey

Given the patient's history of eczema and the characteristic appearance and distribution of the lesions, vesicular hand dermatitis (dyshidrotic eczema) was considered as the primary differential diagnosis. The recent exposure to gel nail polish products containing potential allergens supported this hypothesis. HPV-related warts were ruled out based on previous negative testing and the acute onset pattern. Fungal infection was considered but deemed less likely given the unilateral presentation and vesicular morphology.

Final Diagnosis

Vesicular hand dermatitis (dyshidrotic eczema), likely triggered by contact allergens in gel nail polish

Treatment Plan

Patient education regarding the non-contagious nature of the condition to alleviate anxiety. Recommendation to discontinue gel nail polish and avoid similar products. Topical corticosteroid therapy was discussed, utilizing the patient's existing prescription. Cool compresses were recommended for symptom relief. Avoidance of potential triggers and irritants was emphasized.

Outcome and Follow-up

Patient was reassured about the benign nature of the condition and its lack of contagiousness. She was advised to monitor for resolution over the following weeks and to contact healthcare providers if symptoms worsened or failed to improve. Follow-up was scheduled in 2-3 weeks to assess treatment response and discuss long-term management strategies for her underlying eczema.