Which diagnosis is described by vesiculobullous lesions on the hands and soles with small, tense vesicles and a tapioca pudding appearance?

• A. Tinea manuum
• B. Psoriasis on hands
• C. Palmoplantar eczema; vesiculobullous disorder of hands and soles that forms small, tense vesicles on lateral aspects of fingers that can grow and become bullae; deep-seated appearance have tapioca pudding
• D. Contact dermatitis

Answer: (C)

Dyshidrotic hand dermatitis (a palmoplantar vesiculobullous eczema) is the pattern here. It produces small, tense vesicles on the palms and the sides of the fingers that can coalesce into bullae, and these vesicles are deep-seated and often described as tapioca-like in appearance. This distinctive vesicle morphology on the hands (and sometimes soles) makes it the best fit for the description.

Tinea manuum typically presents as itchy, scaly plaques on the palm with ring-like borders rather than discrete, tapioca-like vesicles. Psoriasis on the hands shows thick, well-demarcated plaques with silvery scales, not a vesiculobullous tapioca pattern. Contact dermatitis can cause vesicles but lacks the specific distribution and the tapioca vesicle appearance characteristic of this condition.