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 are persistent and unexplained.
- Infection (e.g., fungal, bacterial): Infections can cause skin changes and should be considered, especially if the patient has a history of exposure to infectious agents or if the skin changes are accompanied by other symptoms such as redness, warmth, or purulent discharge.
- Rare diagnoses
- Sclerodactyly: This is a rare condition characterized by thickening and hardening of the skin, which can cause skin tightness and limited mobility. Although the patient's symptoms are not typical of sclerodactyly, it should be considered in the differential diagnosis.
- Raynaud's phenomenon: This is a rare condition that affects blood flow to the fingers and toes, causing skin changes and sensitivity. Although the patient's symptoms are not typical of Raynaud's phenomenon, it should be considered in the differential diagnosis, especially if the patient has a history of cold intolerance or other symptoms suggestive of Raynaud's.