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Discussion

We report a case of refractory occupational chronic irritant hand dermatitis with hyperkeratotic morphology successfully treated with dupilumab despite ongoing occupational exposures. Hand dermatitis can be broadly subtyped based on chronicity (acute, subacute, or chronic), etiology (endogenous, such as atopic, or exogenous, such as irritant or allergic), and clinical findings (vesicular, hyperkeratotic, or nummular). 2 Irritant contact dermatitis of the hands is a diagnosis of exclusion. A thorough history, review of the patient's personal and occupational exposures and habits, clinical morphology, and additional testing help confirm the diagnosis. Patch testing should be performed to assess for allergic contact dermatitis. Skin biopsy may be required in certain cases to rule out other dermatoses, such as psoriasis, palmoplantar lichen planus, pagetoid reticulosis, dyshidrosiform pemphigoid, and tinea manuum.