A 32-year-old woman is evaluated for a 10-month history of pruritus and scaling of both her hands. She is a child care worker and washes her hands frequently. Her medical history is unremarkable, and she takes no medications. On physical examination, vital signs are normal. There is no scale or erythema of the feet, and the remainder of the examination is normal. Results of potassium hydroxide microscopy from the scale on her hands are negative.

Which of the following is the most appropriate management?

1) Epicutaneous patch testing
2) Oral fluconazole
3) Oral prednisone
4) Thick emollients

The patient's symptoms suggest contact dermatitis, often caused by excessive hand washing that leads to skin moisture loss. The most effective treatment in such cases is the use of thick emollients to restore moisture and soothe itching. Other options mentioned are not typically used in these cases.

Explanation:

The patient's pruritus and hand scaling, combined with her frequent hand-washing, suggests contact dermatitis or eczema, which is a skin condition characterized by itchy, red, and dry skin. The recommended treatment for contact dermatitis, particularly when caused by excessive skin moisture loss due to frequent hand washing, is to moisturize the skin regularly. Thick emollients, which are substances that soothe and hydrate the skin, are generally recommended for such cases. They help recover the moisture balance of the skin and provide soothing relief from itching.

Oral fluconazole and oral prednisone are not the best choices here as they are used for fungal infections and severe inflammatory conditions respectively. Epicutaneous patch testing may be used for identifying skin allergies but considering the information provided, it's not the first line of management.

Thus, considering all options, Thick emollients is the most appropriate management for her condition.

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