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4

Hand and foot dermatitis is not a single disorder. Rather, it is a categorization of dermatitis that affects the hands and feet selectively due to one of several causes.

Patients often present with isolated dermatitis of the hands or feet. Causes include

• Contact dermatitis
• Fungal infection
• Psoriasis
• Scabies

Other causes include systemic viral infection in children (hand-foot-and-mouth disease—see Enteroviruses: Hand-Foot-and-Mouth Disease) or certain chemotherapies (hand-foot syndrome). Some cases are idiopathic.

Diagnosis can sometimes be inferred from location and appearance of the skin lesions (see Table 4: Dermatitis: Differential Diagnosis of Hand Dermatitis).

Treatment of all forms of hand and foot dermatitis should be directed at the cause when possible. Topical corticosteroids or antifungals may be tried empirically. Patients should also avoid prolonged contact with water that would otherwise remove protective oils and lead to paradoxical drying of the skin.

Table 4
Differential Diagnosis of Hand Dermatitis Appearance of Lesion Location Palm Dorsum Erythema and scaling ACD ICD (variant of ACD or ICD) Hyperkeratotic eczema Keratolysis exfoliativa Psoriasis Atopic dermatitis ACD ICD (variant of atopic dermatitis, ACD, and ICD) Nummular eczema Psoriasis Pustules Dyshidrotic dermatitis Infection (bacterial) Psoriasis Infection (bacterial) Psoriasis Scabies (web spaces) Tinea Vesicles ACD Dyshidrotic dermatitis ACD Id reaction Scabies (web spaces) ACD = allergic contact dermatitis; ICD = irritant contact dermatitis.

Dyshidrotic dermatitis: Pruritic vesicles or bullae on the palms, sides of the fingers, or soles are characteristic of this disorder. Scaling, redness, and oozing often follow vesiculation. Pompholyx is a severe form with bullae. The cause is unknown, but fungal infection, contact dermatitis, and id reactions to tinea pedis can cause a similar clinical appearance and should be ruled out. Treatment includes topical corticosteroids, tacrolimusSome Trade Names
PROGRAF
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or pimecrolimusSome Trade Names
ELIDEL
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, oral antibiotics, and ultraviolet light.

Keratolysis exfoliativa: Painless patchy peeling of the palms, soles, or both is characteristic of this disorder. The cause is unknown; treatment is unnecessary because the condition is self-resolving.

Hyperkeratotic eczema: Thick yellow-brown plaques on the palms and sometimes soles are characteristic of this disorder. The cause is unknown. Treatment is with topical corticosteroids and keratolytics, oral psoralen plus ultraviolet A (PUVA), and retinoids.

Id reaction: The appearance of vesicles usually on the sides of the fingers in response to active dermatitis elsewhere is characteristic of this disorder. The cause may be an allergic reaction.

Housewives' eczema: This irritant contact dermatitis affects people whose hands are frequently immersed in water. It is worsened by washing dishes, clothes, and babies because repeated exposure to even mild detergents and water or prolonged sweating under rubber gloves may irritate dermatitic skin or cause an irritant contact dermatitis.

Hand-foot syndrome: This disorder (also called acral erythema or palmar-plantar erythrodysesthesia) represents cutaneous toxicity caused by certain systemic chemotherapies (eg, capecitabineSome Trade Names
XELODA
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, cytarabineSome Trade Names
CYTOSAR-U

, fluorouracilSome Trade Names
ADRUCIL
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, idarubicin, doxorubicinSome Trade Names
ADRIAMYCIN
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, taxanes, methotrexateSome Trade Names
RHEUMATREX
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, cisplatinSome Trade Names
PLATINOL
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, tegafur). Manifestations include pain, swelling, numbness, tingling, redness, and sometimes flaking or blistering of the palms or soles. Treatment is with oral or topical corticosteroids, topical dimethylsulfoxide, oral vitamin B₆ (pyridoxine), OTC analgesics (eg, acetaminophenSome Trade Names
GENAPAP
TYLENOL
VALORIN
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, ibuprofenSome Trade Names
ADVIL
MOTRIN
NUPRIN
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), and supportive measures (eg, cool compresses, minimizing manual tasks).

Last full review/revision September 2009 by Karen McKoy, MD, MPH

Content last modified September 2009