Hand & Foot Rashes

Hand and foot rashes are generally nonspecific, but their presence or absence might help in establishing the diagnosis in a wide variety of conditions. The palms and soles are covered with squamous epiderma that is thicker than in other parts of the body (1.5 mm) and hairless; the innervation is abundant and contains specialized receptors, such as Meissner and Ruffini corpuscles. On hands and feet, edema is likely to be noticeable early (along with the eyelids/face and the genitalia) due to a relative skin excess.

Differential Diagnosis

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

  Treatment

  • Directed toward the causative condition
  • Skin disorders: Topical steroids, wet dressings, and antibiotics for secondary infections; psoriasis requires UV light and topical applications of tar products
  • Viral infections: Generally self-limited and do not require supportive treatment; acyclovir may have a role in treating HFMD
  • Kawasaki disease: Treat with IVIG, high-dose aspirin
  • Bacterial infections require antibiotics (RMSF, Lyme disease, syphilis, streptococcal infections, TSS, rat-bite fever)
  • Fungal infections require topical antifungal treatment
  • Parasitic infections: Topical permethrin or lindane for scabies
    –Pyrimethamine and sulfadiazine for congenital toxoplasmosis (regardless of symptoms)
  • Acrodermatitis enteropathica: Lifelong oral zinc supplements

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Leg rash

Read excerpts from these other book chapters related to Leg rash:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Leg rash

• Back to symptom: Leg rash: Introduction (review 15 causes)
• Next Book Extract About Leg rash: LEG PAIN (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Leg rash

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: LEG PAIN (Differential Diagnosis in Primary Care)

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