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December 2001

Papules on the Hands

Author Affiliations


Arch Dermatol. 2001;137(12):1647-1652. doi:

A 49-year-old healthy white man presented with a 3-week history of multiple rapidly appearing papules on his hands. The lesions had been mildly itchy. The patient denied any trauma, recent travel, and similar lesions elsewhere. He had been applying an over-the-counter cortisone preparation, thinking that he had "a rash."

Physical examination revealed many discrete, erythematous papules symmetrically distributed over the lateral aspect of the index fingers (Figure 1). Similar-appearing, more subtle lesions were also seen on the skin overlying the dorsal distal and proximal interphalangeal joints, although the patient had not complained of lesions in those locations (Figure 2). The papules were fairly firm and nontender. There was no hand swelling, and joint movement was not restricted. There was no axillary lymphadenopathy. A punch biopsy specimen was obtained (Figure 3).