Hand and foot rashes

Hand and foot rashes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

• The most common etiologies of hand and foot rashes are irritant and dyshidrotic eczema
• Hand and foot rashes look very different, thus a careful examination is required to make a differential

Diagnosis

• Possible dermatology referral

History and Symptoms

• Chronic exposure to harmful chemicals or irritants
• Family history (allergy / atopy, psoriasis)
• Presence of small, clear blisters
• Nail examination
• Examine joints

Laboratory Findings

• Culture of pustules
• Scale scrap (KOH prep)
• Fungal culture of nail

Other Diagnostic Studies

• Patch test
• Punch biopsy

Differential Diagnosis of Causes of Hand and foot rashes

• Dyshidrotic Eczcema
• Erythema multiforme
• Irritant or allergic hand Eczema
• Keratoderma
• Pityriasis rubra pilaris
• Psoriasis
• Reiter's Disease
• Scabies
• Secondary Syphilis
• Tinea manus (hand)
• Tinea pedis (foot)
• Varicella
• Meningococcemia

Treatment

• Avoid wet-work, harsh soaps, offending agents (irritants)
• Bland heavy emollients
• Topical or systemic phototherapy with psoralen with ultraviolet A phototherapy (PUVA)

Pharmacotherapy

Acute Pharmacotherapies

• Topical steroid ointments
• Topical antifungal agents
• Oral antifungals (for onychomycosis)
• Systemic methotrexate
• Cyclosporine

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