A 36-year-old homeless man presented with a 3-week history of bilateral, symmetrical, scaly, and painful dermatitis in both hands up to the rim of the sleeves (Figure) and watery bloody diarrhea. Anxiety, headaches, and tremors were also present. He had been consuming 6 to 8 liters of wine every day for the past 11 years. He used to wear a hooded sweatshirt, not having other photoexposed areas. The skin biopsy demonstrated hyperkeratosis with focal parakeratosis and dilatation of the superficial dermis capillary (Supplemental Figure, available online at http://www.mayoclinicproceedings.org ).