hand fungus? please help diagnose

Greetings,

A Facebook friend of mine lives in the South of Somalia in an area where there's not much medical care available. He sent me a photo of his hand, asking me to figure out what he has and how to treat it. The photo is here: http://www.facebook.com/media/set/?set=a.10150476103614257.422628.629319256&type=1&l=21212e3a57

Thanks very much.

Nathan H
Vienna, Austria

[maatson]

'Hypertrophic lichen planus' would be a photo- diagnosis. But without history and other features like onset, itchy or non-itchy.whether other areas are affected will be difficult to give more specific differential diagnosis.

[Nathey]

Thanks very much for this. I registered on another site that I have to pay for and got a long reply from a dermatologist who also suggested lichen planus. The problem has come and gone since 2004. It is itchy, on his hands and feet, and also affects his joints, which made me think it might be psoriatic arthritis. I think the other dermatologist pretty much has the question covered, and I've been passing a lot of info back and forth between him and the patient. If you want to stay in the loop on this, do let me know, and in any case, thank you again. If there's a problem on the other site or I have any follow-up questions, I'll be back in touch. Sincerely, N.

[maatson]

The clinical features do not suggest psoriasis. I did have a look at the feet leisons too,The violaceous plaques and the exuberant hand lesions need to be biopised for a firmer diagnosis.
Also the HIV status should be known to rule out 'kaposi's sarcoma' especially due to the joint involvement and the violaceous color of the foot plaques.
Best wishes.

[Nathey]

Thanks, that's good of you.

1. What about the clinical features does not suggest psoriasis? The other doctor, Dr Nair, thinks it is probably arthritic psoriasis.

2. Mohamad wrote that he thinks it's not arthritic psoriasis, simply because the doctor has not seen him personally. Also, he says that "the other problem is at the summer day they r so hard" and "when rain comes they become more fungus".

3. He's 20 now and has had whatever it is since 2004, and I think it's unlikely but not impossible that he contracted HIV in a Muslim country when he was 14. Áccording to this link, 0.7% of adults in Somalia are HIV positive: http://hivinsite.ucsf.edu/global?page=cr09-so-00

Thanks again.

[maatson]

From the age he has these symptoms it is true the likelyhood of HIV is less so, but not impossible.
The photodiagnosis does not suggest Psoriasis despite arthropathy.

Infact I would look with the present feedback for local endemic disease like Pinta.(Endemic treponematosis)
The papules are known as 'Pintids' and caused by non-venereal treponematosis.they are caused by 'Treponema carateum'.
This occurs in young adults. Respose to penicillin is striking.
Serologic tests for Syphilis would be positive,though this is non- sexual.

Wish some one works it up with necessary investigations back there! Best wishes.