Bilateral palmar rash

Abstract

A 61-year-old woman presented to the Family Medicine Skin Care Clinic with a 1-year history of an asymptotic rash on her hands. Physical exam revealed a scattered array of blanching, 1- to 3-mm erythematous macules on the palmar aspect of both hands and a few similar lesions on the dorsum of her hands and chest. She denied myalgias, exophthalmos, or history of Raynaud syndrome. The patient smoked 1 pack of cigarettes per day.What’s your diagnosis?