Case report: False nails and a hand rash

You can postpone treatment for a rash only so long. I was consulted urgently by a 26-year-old, fair-skinned female who was flying to Europe that same evening. She was concerned about a slightly painful, very itchy rash on her hands. She came to our clinic on a Sunday (one of the days we happen to be open). The patient was in good health, with no previous illness, no previous rashes, no known allergies and taking no medications. In preparation for her long-awaited trip abroad, the previous day she had, for the first time, had fancy, false nails applied. She awoke next morning (the day she was seen) with a rash on her hands. Read: Case report: Could it be ringworm? As seen (not dramatic) in the picture attached, the young woman had a slightly red, tender, very pruritic band of erythema, proximal to the base of every dramatic false finger nail. I believe that the diagnosis was straightforward— allergic/contact dermatitis arising from the adhesive (less likely the nail material) used to bond the nails to the fingers. Unfortunately, with only hours to spare on a Sunday, the nail people were closed. The patient reported that she could not remove the nails herself, as a special, super-strong glue is used—only removable by a professional with the appropriate solvents. Fairly sure of my diagnosis, I prescribed topical application of Elocom (steroid) cream two or three times a day to reduce the inflammation, which I think will worsen. I also prescribed Rupall, an effective antihistamine, to help control the rash and reduce itch. I contemplated oral prednisone, but did not prescribe it. I did mention the possibility to the patient. If necessary, surely medical care could be accessed in Europe. Read: Case report: A persistent rash The patient learned—and I was reminded—that it is wise to plan well ahead when taking a trip away from usual medical care. It seems unwise to do something new, immediately before leaving. I hope to hear that she enjoyed her vacation. Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files. Read: Case report: Does this need stitches?

Case report: False nails and a hand rash

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