“It's my hands, Doc. They've been itching and burning for the past month and they're driving me crazy,” a thirty-eight-year-old woman complained. What we mainly saw were the rough red scaling backs of her hands. But on her palms we also saw some scattered pinpoint-sized deep blisters filled with fluid, the so-called vesicles. Her skin elsewhere was clear. She had no fungus infection of her feet.

She was a housewife and had just passed a complete physical examination with blood studies, trying to find out why her hands itched and were so inflamed.

It was another case of “round up the usual suspects,” with the line up including contactants, drugs, and foods. There was no unusual exposure of her hands to solvents, detergents or disinfectants. She denied excessive handwashing, a compulsive behavior easily controlled with fluoxetine (Prozac®). She had no hobbies such as flower arranging, with exposure to chrysanthemums, primula, or tulip bulbs. Her problem was a straightforward eczema. We could elicit no medication as a cause. She did not have a photodermatitis, for other light-exposed areas were clear.

Much to her surprise, we focused on foods as a cause. We have seen many chronic hand eczemas due to food allergy – not just from contact, but from eating a particular food. Pork is one of the most common causes. “Ham sandwich” hand dermatitis is quite common and often unrecognized.