Unilateral Erythematous Lesion on Hand in Young Adult

Case at a Glance

A 21-year-old female presents with a recently developed red, non-pruritic, non-tender rash on her left hand occurring during recovery from an upper respiratory infection.

Patient's Story

The patient noticed an unusual red rash-like area that appeared on her left hand over the past few days. She reports being unwell for approximately two weeks with cold symptoms and has been managing her illness with over-the-counter cold and flu medications. The patient denies any pain, itching, or discomfort associated with the lesion. Her medical history is significant for iron deficiency anemia, and she has a social history of vaping. She denies taking any other medications or supplements beyond the cold remedies.

Initial Assessment

Physical examination revealed a well-demarcated erythematous area on the dorsal aspect of the left hand. The lesion appeared non-elevated, without scaling, vesicles, or purulent discharge. No similar lesions were noted elsewhere on the body. The patient appeared otherwise well, with resolving upper respiratory symptoms. Vital signs were within normal limits.

The Diagnostic Journey

Given the recent onset during a viral illness and the characteristic appearance, differential diagnoses considered included viral exanthem, contact dermatitis, drug-related eruption from cold medications, or post-infectious erythema. The unilateral presentation and timing suggested a possible relationship to her recent illness or medication use.

Final Diagnosis

Post-viral erythema with possible contribution from over-the-counter cold medication sensitivity

Treatment Plan

Conservative management with observation was recommended. The patient was advised to discontinue current cold medications if symptoms had resolved and monitor the lesion for changes. Application of gentle moisturizer and avoidance of potential irritants were suggested. A follow-up appointment was scheduled in one week to assess progression.

Outcome and Follow-up

The patient was counseled to return if the lesion expanded, became symptomatic, or if new lesions developed. Educational materials regarding potential medication reactions and when to seek further medical attention were provided. Iron deficiency management was also discussed as a separate health maintenance issue.