A 59-year-old nurse from Mauritius presented with a 4-year history of exertional dyspnea, arthralgia, and malaise. She also had symptoms of Raynaud phenomenon and arthritis. She had been very concerned about her hands: they were rough and sore and had not improved with the use of emollients or topical corticosteroids, which had been prescribed by her family physician for “hand eczema.”
Physical examination revealed fingernail clubbing. The radial surfaces of the patient’s hands were hyperkeratotic, with marked fissuring but no underlying erythema (Figure 1 and Figure 2). Her feet were similarly affected. She also had proximal muscle weakness, and fine inspiratory crepitations were heard at both lung bases. Serologic testing revealed positivity for anti–Jo-1 antibody.
White JML, Salisbury JR, Creamer D. Eczematous Changes on the Hands—Quiz Case. Arch Dermatol. 2005;141(6):779–784. doi:10.1001/archderm.141.6.779-c