FM resident here.
I have a 45 y.o female patient w/ a history of celiac disease but strict gluten free diet, she’s a single mom and both her son and her are celiac so there’s just no gluten in the house. Nothing else relevant. 
2 months ago she developed skin lesions on her pinky. They had scabs and blisters, along with erythema and slight edema. It was itchy and painful. This started like a week before we saw here but new lesions were still appearing. My attending and I thought it looked like herpes. We prescribed valaciclovir because even though they started a week ago we thought it might stop the progression.
We saw her 2 weeks later. She still had it, but now in both pinkies. Skin would come off, then grow back, new lesions, then come off again, grow back…
We prescribed oral corticoids and took cultures which grew negative. She didn’t take the corticoids because she wasn’t comfortable with that.
We consulted dermathology. They saw her and said it was just a regular hand eczema. Prescribed topic corticoids and topic tacrolimus, she had a mild response, it would improve slightly on some spots but appear/get worse on others.
Blood work was irrelevant. This is what it looks like now but it’s pretty much a cycle repeating what i described, ir starts as the finger with the smaller lesion, evolves to what the other one looks like, heals and starts again.
Anyone can think of anything?? She has an office job, cleans her house with gloves… so not a contact dermathitis… i honestly don’t know what to do (nor my attending).

What’s this “Hand eczema”? 😂