Nargile (Hubble-Bubble) smoking-induced hand eczema

A 65-year-old retired man with hand eczema presented to the Dermatology clinic in October of 2001. He complained of scaly, fissured plaque-type lesions over the radial margin of his right index finger and thumb (Fig. 1). He first noticed these changes 2 years ago. There was no history of irritation from his occupation. None of the other family members were affected. There was no history of atopy or psoriasis. The physical examination was remarkable for scaly, fissured, hyperkeratotic patches on the palms and palmar surfaces of the finger tips of the right hand. No nail changes were noted. The other fingers were free from lesions. There were no changes on the feet or soles. A diagnosis of eczema was suspected. Hobbies and repeated trauma to the hands were investigated. He had a habit of "nargile" smoking,starting at 35 years of age and he was using this apparatus more than 2 h a day. We performed patch tests with European standart test serial and they were negative. Yeast examination using KOH was negative. The diagnosis of Nargile (Hubble-bubble) eczema was made. It was advised that he stop smoking. Mild topical corticosteroids and emollient with urea were started. Clinical evaluation demonstrated resolution of the lesions after 2 weeks of therapy.