A 43-Year-Old Man with Pruritic, Scale Plaque and Vesicles on His Hands and Arms

The patient is a 43-year-old man who presents to urgent care after work with an extremely pruritic fine scaly plaque and tense vesicles covering his hands and arms. He had been  gardening the previous weekend, worked on his car, and prepared his boat for its first voyage of the season. He wasn’t sure which activity might have caused such a terrible rash.

View the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.