Skin Eczema Limited to Transplanted Hand.

Abstract

Hand transplantation is a vascularized type of composite tissue allotransplantation (CTA), involving the transfer of heterogeneous tissues such as skin, fat, bones, muscles, and nerves. Even with modern immunosuppression protocols, rejection remains a major obstacle in this field. We report the first documented case of eczema limited to the skin of a transplanted hand in a 38-year-old male born without a left hand. The patient underwent hand allotransplantation in December 2016 from a deceased donor with complete HLA mismatch and remained on stable triple immunosuppressive therapy. Six years post-transplantation, erythematous macules, papules, scaling, and increased keratosis appeared exclusively on the dorsal and palmar aspects of the grafted hand, involving approximately 80% of its skin surface, without lesions elsewhere. Histopathological examination confirmed subacute eczema, with no signs of acute or chronic rejection. Topical mometasone furoate ointment combined with an increased dose of oral prednisone (from 5 mg/day to 10 mg/day) resulted in marked improvement within two weeks, followed by complete resolution after several weeks of regular emollient use. No recurrence was observed during six months of follow-up. This case highlights the importance of differentiating between rejection and other dermatological conditions, such as eczema, in limb transplant recipients. Because eczema can closely mimic rejection, it may complicate post-transplant care and lead to unnecessary changes in immunosuppressive therapy if misdiagnosed. Accurate diagnosis is essential for appropriate management and graft survival.