Diagnosis of Hand eczema

Hand eczema Diagnosis: Book Excerpts

• Differential Diagnosis - Hand and Foot Rashes
• Differential Diagnosis - Hand & Foot Rashes
• Approach to the Diagnosis - HAND AND FINGER PAIN
• Diagnosis - Atopic dermatitis
• Diagnosis - Dermatitis
• Differential Overview - Arthritis/Dermatitis
• Diagnosis - Atopicdermatitis
• Diagnosis - Dermatitis
• Approach to the Diagnosis - HAND AND FINGER PAIN

Diagnostic Tests for Hand eczema: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Hand eczema.

Hand and Foot Rashes: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Dyshidrotic eczema (pompholyx)
  –Very common idiopathic skin disease
  –Affects one or both hands and/or feet in the thenar eminence, palms and/or soles, and sides of fingers and toes
  –Causes itching, scaling, and erythema, and minute vesicles and painful fissures
  –Usually chronic and intermittent, and often exquisitely pruritic

• Irritant or allergic hand eczema
  –Very common
  –Difficult to distinguish from dyshidrosis because both are vesicular and very itchy
  –Flares occur during work/hobbies, with improvement on vacation when away from the irritant or allergen
• Tinea manus (hand) and tinea pedis (foot)
  –Presents as itchy, diffuse, light scale, and/or maceration; prominent on palmar, plantar (moccasin distribution), and interdigital surfaces
  –Erythema is rarely present
  –Often “two hands and one foot” or “two feet and one hand” are affected
• Scabies
  –Presents as short (a few millimeters), linear burrows and vesicles on the hands and feet (web spaces), belt region, and/or intertriginous spaces
  –Intensely pruritic, especially at night
  –Often many members of the household unit affected
  –Definitive diagnosis made by visualizing the scabies mite in a skin scraping

• Psoriasis
  –Often affects the hands and/or feet
  –Well-demarcated, erythematous plaques
  with adherent scale, or can present as a focal or diffuse pustular eruption
  –Look for associated nail dystrophy or other skin involvement

• Pityriasis rubra pilaris
  –Well-demarcated bright salmon or red plaques on the palms or soles

• Keratoderma
  –Focal or diffuse thickening of the skin of the palms or soles

Workup and Diagnosis

• History and physical examination
  –Note chronic exposure to chemicals or potential irritants at work or in hobbies
  –Any family history of psoriasis or allergy/atopy
  –Look closely for the presence of small, clear “water blisters” under the skin that may indicate pompholyx
  –Examine nails for evidence of coexisting onychomycosis (very common in cases of tinea pedis and manus, and a nidus for frequent reinfection), “oil spots,” or nail pitting (may suggest psoriasis)
  –Examine joints for arthritis (psoriasis/Reiter's), eyes (Reiter's), and genitalia (psoriasis/Reiter's)

• KOH preparation from scale scraped from the palms, soles, or between the toes to determine presence of branching hyphae of tinea or scabies mites
• Culture any intact pustules
• Consider performing a patch test to rule out allergic contact dermatitis
• A punch biopsy may be helpful to distinguish psoriasis or PRP from the other common eczematous diseases of the hands and feet
• Fungal culture of nail clipping if onycholysis (nail thickening) present
• Dermatology referral is often indicated in resistant cases

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Hand & Foot Rashes: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Infectious

• Enterovirus infection (hand-foot-and-mouth disease, Coxsakie virus, other nonpolio enteroviruses)
• Kawasaki disease (one of the five criteria)
• Scabies
• Tinea
• Candidal skin infection
• Ricketsial rash: Rocky Mountain spotted fever (RMSF), murine typhus
• Mononucleosis (EBV)
• Measles: Atypical forms start on hands/feet
• Scarlet fever, post-streptococcal infection desquamation rash
• Infectious endocarditis: Janeway lesions, Osler nodules
• Spirochete infection: Secondary syphilis, Lyme disease (acrodermatitis chronica atrophicans)
• Congenital toxoplasmosis
• Rat-bite fever (Streptobacillus moniliformis, Spirillum minus)
  Immune-mediated
  • Urticaria: Hands and feet involved in 85% of the cases
  • Juvenile rheumatoid arthritis
  • Systemic lupus erythematosus
  • Raynaud phenomenon (acrocyanosis)
  • Acute graft-vs-host disease
    Skin disorders
  • Atopic dermatitis (infantile)
  • Dyshydrotic eczema, pompholyx
  • Chronic allergic contact dermatitis
  • Psoriasis
  • Lichen simplex
  • Papillon-Lefèvre syndrome
  • Olmsted syndrome
  • Acrodermatitis enteropathica (zinc deficiency) can be presenting sign of cystic fibrosis
  • Toxic shock syndrome: Desquamation during the recovery phase; major criteria for staphyloccocal TSS
  • Drugs: Ampicillin, especially in patients with infectious mononucleosis
  • Chronic liver disease: Cirrhosis, hepatoma
  • Metabolic disease: Gangliosidosis
  • Malignancy: Acute leukemia, lymphoma

  Workup and Diagnosis

  • History
    –Season of onset (can be a clue for various infectious etiologies)
    –Patient's age
    –Presence of fever, pruritus (typical of urticaria)
    –Tick/rat/bat bites (e.g., rat bite fever or Lyme disease)
    –Travel (to endemic areas for Lyme, RMSF)
    –Sick contacts
    –Contact allergen
  • Physical exam
    –Rash pattern and distribution, desquamation (interdigital, periungal), edema, involvement of other areas of the body
    –Other signs and symptoms associated (oral lesions, URI symptoms, arthritis, genital chancre)
    –Verify criteria for disease such as Kawasaki, Lyme, juvenile rheumatoid arthritis
  • Labs
    –CBC, ESR/CRP
    –Serologic testing for RMSF, Lyme, syphilis, toxoplasmosis, SLE
    –Throat swabs and stool culture for enterovirus serotype (no therapeutic significance)
    –KOH prep for hyphae
  • ECG, echocardiography, and cardiology consult if Kawasaki disease or endocarditis is suspected

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

HAND AND FINGER PAIN: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

In diagnosis, most of these conditions will be obvious on inspection. The difficulty arises when the hand looks normal. Then one must check for the following:

1. Carpal tunnel syndrome by tapping the volar aspect of the wrist (Tinel sign)
2. Brachial plexus neuralgia and scalenus anticus syndrome by Adson tests
3. Causalgia by stellate ganglion block to see if pain is relieved
4. Cervical spine disease by a roentgenogram, possibly a myelogram or MRI, and nerve blocks of the various roots. Referral to a neurologist is often necessary. In early rheumatoid arthritis, the joints may be normal on inspection but pain and stiffness of the hands and fingers in the morning is an excellent clue.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

Atopic dermatitis: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

Typically, the patient has a history of atopy, such as asthma, hay fever, or urticaria; his family may have a similar history. Laboratory tests reveal eosinophilia and elevated serum IgE levels. A skin biopsy may be performed, but it isn’t always required to make the diagnosis.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Dermatitis: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

A family history of allergy and chronic inflammation suggests atopic dermatitis. Typical distribution of skin lesions rules out other inflammatory skin lesions, such as diaper rash (lesions are confined to the diapered area), seborrheic dermatitis (no pigmentation changes, or lichenification occurs in chronic lesions), and chronic contact dermatitis (lesions affect hands and forearms, sparing antecubital and popliteal areas). Serum IgE levels are usually elevated.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Arthritis/Dermatitis: Differential Overview
(Field Guide to Bedside Diagnosis)

❑Lyme disease

❑Erythema nodosum

❑Rheumatoid arthritis

❑Systemic lupus erythematosus

❑Psoriatic arthritis

❑Disseminated gonococcemia

❑Sarcoidosis

❑Scleroderma

❑Dermatomyositis

❑Reiter syndrome

❑Rheumatic fever

❑Behçet syndrome

❑Still disease

❑Hypersensitivity vasculitis

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Atopicdermatitis: Diagnosis
(Handbook of Diseases)

Typically, the patient has a history of atopy, such as allergic rhinitis asthma, or urticaria; family members may have a similar history. Laboratory tests reveal eosinophilia and elevated serum immunoglobulin E levels.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Dermatitis: Diagnosis
(Handbook of Diseases)

A family history of atopic disorders is helpful in the diagnosis of atopic dermatitis.

Typical distribution of skin lesions and course rule out other inflammatory skin lesions, such as diaper rash (lesions confined to the diapered area), seborrheic dermatitis, and chronic contact dermatitis (lesions affect hands and forearms, sparing antecubital and popliteal areas). Serum IgE levels are commonly elevated but aren’t diagnostic.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

HAND AND FINGER PAIN: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

In diagnosis, most of these conditions will be obvious on inspection. The difficulty arises when the hand looks normal. Then one must check for the following:

1. Carpal tunnel syndrome by tapping the volar aspect of the wrist (Tinel sign)
2. Brachial plexus neuralgia and scalenus anticus syndrome by Adson tests
3. Causalgia by stellate ganglion block to see if pain is relieved
4. Cervical spine disease by a roentgenogram, possibly a myelogram or magnetic resonance imaging (MRI), and nerve blocks of the various roots. Referral to a neurologist is often necessary. In early RA, the joints may be normal on inspection, but pain and stiffness of the hands and fingers in the morning is an excellent clue.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

 » Next page: Signs of Hand eczema

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Signs of Hand eczema
• Complications of Hand eczema
• Misdiagnosis of Hand eczema
• Undiagnosed Hand eczema
• Misdiagnosis of Underlying Causes of Hand eczema

Tools & Services:

• Bookmark this page
• Take a survey relating to Hand eczema
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City