Hand Dermatitis

Aka: Hand Dermatitis, Foot Dermatitis, Distal Extremity Rash, Acral Skin Lesion, Palm and Sole Desquamation, Palm and Sole Pustules, Palmoplantar Rash

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II. Causes: Itchy Blister

  1. Dyshidrotic Eczema
  2. Nummular Eczema
  3. Contact Dermatitis
  4. Tinea Manum and Tinea Pedis
  5. Insect Bite reaction

III. Causes: Erosion and excoriation

  1. Impetigo or super-infected dermatitis (most common)
    1. Treat with Dicloxacillin or Erythromycin x7-10 days
  2. Scabies

IV. Causes: Blister becoming Pustule

  1. Eczematous Dermatitis
  2. Tinea Manum or Tinea Pedis
  3. Psoriasis
  4. Palmoplantar Pustulosis (Pustular Psoriasis)

V. Causes: Pustule

  1. Bacterial Infection (Most common)
    1. Staphylococcus aureus most common cause
  2. Fungi (dermatophytes, tinea)
  3. Psoriasis
  4. Old Blisters collecting debris

VI. Causes: Solitary or scattered Pustules

  1. Bacterial Infection or Sepsis
    1. Consider NeisseriaGonorrhea, Candida
    2. Culture!
    3. Suspect Sepsis with Hemorrhagic Pustules
  2. Sporotrichosis
  3. Herpes simplex (Whitlow)

VII. Causes: Scaly Papules and Plaques

  1. Psoriasis
  2. Secondary Syphilis
  3. Reiter's Syndrome
  4. Bowen's Disease (Squamous Cell Carcinoma In Situ)
  5. Discoid Lupus (scarring)
  6. Tinea does not usually present with multiple lesions
  7. Palmoplantar Pustulosis (Pustular Psoriasis)

VIII. Causes: Red palms and or soles with Generalized Rash

  1. Systemic Lupus Erythematosus
  2. Dermatomyositis
  3. Kawasaki Disease (followed by Desquamation)
  4. Liver disease
  5. Drug Eruption
  6. Viral Exanthem

IX. Causes: Desquamation palms and soles

  1. Kawasaki Disease (late finding)
  2. Scarlet Fever
  3. Toxic Shock Syndrome
  4. Drug Eruption
  5. Dyshidrosis
  6. Mercury Poisoning
  7. Chikungunya

X. Causes: Pigmented lesions

  1. Acral Lentiginous Melanoma
  2. Racial trait
  3. Postinflammatory pigment

XI. Causes: Painful palm and sole lesions

  1. Bacterial Endocarditis
    1. Osler Nodes (Painful raised lesions on palms and soles)
    2. Janeway Lesions (Painless hemorrhagic Nodules on palms or soles)

XII. Causes: Miscellaneous Hand and Foot Dermatitis

  1. Photodermatitis
  2. Granuloma Annulare
  3. Raynaud's Syndrome
  4. Discoid Lupus
  5. Hyperhidrosis
  6. Vector-Borne Infection
    1. Dengue Fever
    2. Chikungunya

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