dermatologic disorders
Hand and Foot Dermatitis
Diagnosis of Hand and Foot Dermatitis
Clinical evaluation Diagnosis of hand and foot dermatitis can usually be inferred from location and appearance of the skin lesions. Differential diagnosisof hand and foot dermatitis includes Fungal infection Palmoplantar psoriasis Overview of Dermatophytoses , Psoriasis None When dyshidrotic dermatitis and palmoplantar psoriasis coexist When vesicles in dyshidrotic dermatitis become superinfected When patients with palmoplantar psoriasis become sensitized (eg, to topical corticosteroids) and develop an allergic contact dermatitis When palmoplantar psoriasis is triggered (koebnerized) by an allergic contact reaction Many disorders other than dermatitis can affect the hands and feet. Among these are Fungal infections (eg, tinea manuum, Tinea Pedis (Athlete's Foot) , Viral infections (eg, Herpetic Whitlow , Bacterial infections (eg, Impetigo and Ecthyma , atypical Parasitic infections (eg, Scabies , Palmoplantar Keratodermas None Epidermolysis Bullosa (many different subtypes) Cutaneous T-cell Lymphomas (CTCL) None Lichen Planus None Pityriasis Rubra Pilaris None Keratolysis exfoliativa (lamellar dyshidrosis) Hand-foot syndrome Keratolysis exfoliativa(also known as lamellar dyshidrosis or dyshidrosis lamellosa sicca) is not an inflammation of the skin (and thus not a dermatitis). It affects the hands and feet and is characterized by annular erythema over the volar aspects of the hands and feet with air-filled blisters, possibly followed by peeling. Small annular collarettes of white scale may affect the palms (less often the soles) but spare the dorsal hands and feet. No fluid-filled blisters are present. Keratolysis exfoliativa may be aggravated by warm weather, hyperhidrosis, friction, and water contact. Hand-foot syndromeis known by a variety of terms, including acral erythema, palmar-plantar erythrodysesthesia, toxic erythema of the palms and soles, Burgdorf reaction, and toxic erythema of chemotherapy. It represents cutaneous toxicity caused by certain systemic chemotherapies (eg,capecitabine,cytarabine,fluorouracil,idarubicin,doxorubicin, taxanes,methotrexate,cisplatin, tegafur). Symptoms begin with tingling in the palms and/or soles, followed by edema and tender, symmetrical erythema, particularly over the fat pads of the distal phalanges. Pain, numbness, flaking, or blistering of the palms and soles can develop. 