A 51-year-old man was referred to our outpatient department with a tentative diagnosis of atopic hand eczema. He reported scaling and dry skin of both palms since infancy, with no seasonal variation and minimal pruritus. His major complaint was progressive reduction in finger extension. His father and 1 of 2 siblings had similar skin findings since birth. There was no family history of psoriasis, eczema, or cutaneous malignant disease. Previous empirical treatment with high-potency topical corticosteroids, tacrolimus, Grenz rays, and UV-B therapy had been unsuccessful. Fungal samples and patch testing results had been negative.