Eosinophilic Fasciitis of Wrists with a Positive Prayer Sign

Eosinophilic fasciitis (EF) is an uncommon disease of unknown etiology and is characterized by inflammation and thickening of the muscular fascia and subcutaneous tissue. The patients often have peripheral eosinophilia, increased erythrocyte sedimentation rate, and hypergammaglobulinemia. In EF, the skin of the hands and feet are generally spared. Herein we present a case of EF of the wrists with a positive prayer sign and good response to corticosteroid and methotrexate. It is important to emphasize that a positive prayer sign might be the first symptom of EF. The combination regimen of systemic corticosteroids and methotrexate is recommended.