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Hand and Foot Dermatitis

By

Mercedes E. Gonzalez

, MD, University of Miami Miller School of Medicine

Last full review/revision Aug 2019| Content last modified Aug 2019
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Hand and foot dermatitis is not a single disorder. Rather, it is a categorization of dermatitis that affects the hands and feet selectively because of one of several causes.

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

Other causes include systemic viral infection in children (hand-foot-and-mouth disease) or certain chemotherapies (hand-foot syndrome). Some cases are idiopathic.

Diagnosis of hand dermatitis can sometimes be inferred from location and appearance of the skin lesions (see table Differential Diagnosis of Hand Dermatitis).

Treatment of all forms of hand and foot dermatitis should be directed at the cause when possible. Topical corticosteroids 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
icon

Differential Diagnosis of Hand Dermatitis

Appearance of Lesion

Location

Palm

Dorsum

Erythema and scaling

ACD

Dyshidrotic eczema

ICD

Hyperkeratotic eczema

Keratolysis exfoliativa

Psoriasis

Fungal infection (tinea manum)

ACD

ICD

Fungal infection (tinea manum)

Pustules

Dyshidrotic eczema

Infection (bacterial)

Psoriasis

Infection (bacterial)

Psoriasis

Scabies (web spaces)

Vesicles

ACD

Dyshidrotic eczema (dyshidrotic dermatitis)

Id reaction

ACD

Scabies (web spaces)

ACD = allergic contact dermatitis; ICD = irritant contact dermatitis.

Dyshidrotic eczema (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. Symptoms are intermittent and attacks typically last several weeks but are shorter if treated.

Pompholyx is a severe form of dyshidrotic eczema with bullae. The cause of pompholyx is unknown, but fungal infection, contact dermatitis, and dermatophytid (id) reactions to tinea pedis can cause a similar clinical appearance and should be ruled out. Treatment includes potent topical corticosteroids, tacrolimus or pimecrolimus, oral antibiotics (if secondarily infected), and ultraviolet light. Wet compresses with potassium permanganate or aluminum acetate can help relieve symptoms.

Keratolysis exfoliativa

Painless patchy peeling of the palms, soles, or both is characteristic of this disorder. The cause of keratolysis exfoliativa 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. Scaling can occur. The cause of hyperkeratotic eczema is unknown. Treatment is with topical corticosteroids and keratolytics, oral psoralen plus ultraviolet A (PUVA—see Psoriasis : Phototherapy), and retinoids.

Dermatophytid reaction (id reaction)

The appearance of vesicles usually on the sides of the fingers or on the palms or soles in response to active dermatitis elsewhere is characteristic of this disorder. The cause may be an allergic reaction (see Dermatophytid Reaction). The reaction takes multiple forms and may manifest as vesicles, papules, erysipelas-like plaques, erythema nodosum, erythema annulare centrifugum, or urticaria.

Irritant contact dermatitis (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, capecitabine, cytarabine, fluorouracil, idarubicin, doxorubicin, taxanes, methotrexate, cisplatin, tegafur). Manifestations include pain, swelling, numbness, tingling, redness, and sometimes flaking or blistering of the palms or soles.

Treatment of hand-foot syndrome is with oral or topical corticosteroids, topical dimethylsulfoxide, oral vitamin B6 (pyridoxine), over-the-counter analgesics (eg, acetaminophen, ibuprofen), and supportive measures (eg, cool compresses, minimizing manual tasks).

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