Chronic eczema in a person with darker coloured skin always
gives rise to marked post inflammatory hyperpigmentation. This lady has had a
pompholyx like eczema for months with the chronic rubbing reflected in the skin
thickening or lichenification shown here and the marked pigmentation. She
should be investigated by patch testing for a possible contact allergy but can
be managed initially with skin protection using cotton lined rubber gloves when
washing and cleaning and cotton gloves inside plastic gloves when preparing
foods where the juices of fish or meats or from potatoes and tomatoes can act
as irritants and rarely be allergens. A strong steroid cream or ointment such
as betamethasone dipropionate 0.05% should be applied twice daily to settle the
eczema and the hands moisturised. A soap substitute should be used when
washing. Once controlled the hyperpigmentation will gradually fade and the skin
texture return to normal. Any allergen found on testing will have to be
avoided. See www.skinconsult.com.au
for other images.
