Differences in Clinical Characteristics Between Hand Eczema and Hand Psoriasis

Abstract

Abstract: Background: Hand eczema and hand psoriasis are common skin conditions that may present with similar clinical features, making differentiation challenging. Objective: This study aims to identify clinical characteristics that distinguish hand eczema from hand psoriasis. Methods: A retrospective chart review was conducted on patients diagnosed with either condition at the Contact Dermatitis and the Psoriasis Clinic of the Department of Dermatology, Siriraj Hospital, Mahidol University—a national tertiary referral center in Thailand—from January 2015 to November 2022. Results: A total of 398 patients with hand eczema and 140 with hand psoriasis were included. Exogenous (76.1%) and endogenous (23.9%) hand eczema showed similar lesion location and morphology. However, compared with hand psoriasis, endogenous hand eczema more commonly involved the palmar area, palmar side of digits, and finger pulps (P < 0.001). Conversely, hand psoriasis predominantly affected both sides of the wrist, the dorsal side of the hand, nail fold, and the nails (P < 0.001). Clinical manifestations such as papules, vesicles, scales, and fissures were more frequently observed in endogenous hand eczema, whereas hyperkeratotic plaques were more characteristic of hand psoriasis (P < 0.001). Itching was significantly more frequent in hand eczema (P < 0.001). Conclusions: Symptoms, lesion locations, and morphology may provide valuable insights that enhance diagnostic accuracy in distinguishing between hand eczema and psoriasis.