Differential Diagnosis
- Single most likely diagnosis
- Sympathetic dystrophy or complex regional pain syndrome type I (CRPS-I): This condition is characterized by chronic pain, swelling, and changes in skin temperature and color that can occur after a traumatic injury, such as fingernail loss. The patient's symptoms of dry, cracked, and shrunken skin on the palmar surface of the right hand, along with occasional tightness and sensitivity, are consistent with CRPS-I.
- Other Likely diagnoses
- Dyshidrotic eczema: This is a type of eczema that can cause dry, cracked skin and is often triggered by trauma or stress. The patient's history of traumatic fingernail loss and subsequent skin changes could be related to dyshidrotic eczema.
- Irritant contact dermatitis: This is a non-allergic reaction to an irritant that can cause dry, cracked skin. Although the patient denies new exposures or products, it is possible that an irritant was introduced during the healing process of the fingernail loss.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Squamous cell carcinoma or other skin cancers: Although rare, skin cancers can present with skin changes and should be considered in the differential diagnosis, especially if the skin changes do not respond to treatment.
- Infection (e.g., fungal, bacterial): Infections can cause skin changes and should be considered, especially if the patient has a history of immunocompromised state or if the skin changes are accompanied by other symptoms such as fever or redness.
- Rare diagnoses
- Sclerodactyly: This is a rare condition characterized by thickening and hardening of the skin, which can cause skin shrinkage and tightness. Although rare, it should be considered in the differential diagnosis if other causes are ruled out.
- Raynaud's phenomenon: This is a condition that affects blood flow to the fingers and toes, causing skin changes and sensitivity. Although rare, it should be considered in the differential diagnosis if other causes are ruled out.