Hand and foot rashes


 * 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

 * 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)

Acute Pharmacotherapies

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

Acknowledgements
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