Hand rash and arthralgia

[LoJo]

For at least five years now, I've been having a recurring palmar rash that is followed by one red, inflammed, tender, hot DIP joint in the same hand (the finger varies).  I've done some reading about psoriasis and psoriatic arthritis, but the "rash" doesn't resemble any pictures I've seen of psoriasis.  It's comprised of flat, red, circular spots, no bigger than a pencil eraser, and it doesn't itch.  Is this even considered a "rash"?  Any thoughts?  Also, my son has psoriasis over his elbows in the winter, and my daughter has eczema.

[Alan Rockoff, MD]

Not sure.  It doesn't sound like psoriasis to me either.  Common palm rashes include variants of eczema, but these aren't associated with joint swelling.

I think a thorough evaluation by a skin doctor and arthritis specialist should be considered.  If blood work hasn't been done (to check on arthritis variants), it should be.  Good-quality photos may help, in case the appointment doesn't coincide with an outbreak.

Best.

Dr. Rockoff

[LoJo]

The pictures are a good idea.  Thank you.  I'll consider following up with a specialist after the next episode.  My GP said it was contact dermatitis, and that the joint swelling was "from my job."  But I question that diagnosis since they occur together.  If you don't mind me asking another question, does my description of the rash itself (excluding the arthritis) sound like anything you've seen before?  Thanks again.

[Alan Rockoff, MD]

Not really.

ASR