ABSTRACT Eosinophilic fasciitis (EF) is a rare systemic connective tissue disease involving chronic inflammation of muscle fascia and subcutaneous tissue. While the underlying pathogenesis is poorly understood, prior publications have described classic findings to support this unusual diagnosis through clinical presentation, imaging, and histology. We report a unique case of eosinophilic fasciitis in a 24‐year‐old male with a predominantly asymmetric presentation and related hand involvement. Key features of the physical exam, labs and MRI imaging led to the diagnosis, and the patient improved with steroids and eventually transitioned to steroid sparing therapy. This case report highlights an unusual presentation of eosinophilic fasciitis, reviews classic diagnostic criteria and underscores a situation when it may be reasonable to avoid full thickness skin biopsy and opt for early treatment.