Test your diagnostic skills in our regular dermatology quiz. What is the cause and appropriate management of the thick warty crusts on this man’s hands?
A 45-year-old man presents with thick warty crusts on the dorsal and palmar surfaces of both hands (Figures 1a and b). The eruption has been present for three months and is slightly itchy. There is also a brown discolouration of his fingernails.
The rash has been treated with topical corticosteroids but the patient believes these have made the rash worse. Blood tests have been performed and show blood eosinophilia.