Hands and Feet Papules

Papules on the hands  if rough are usually warts and if smoothe consider granuloma annulare.If there is a bit of superficial spreading scale think of tinea manum.Lichenified eczema on the dorsum of the hands is often papular.Knuckle pads as the name implies are seen over the interphalangeal joints.In white populations sun damage will cause basal and squamous cell skin cancers and rarely colloid milium.

If the papules are tiny think of lichen nitidus.If they are on the wrist or dorsum of the hand and purplish think of lichen planus.Papules on the palms may be secondary syphilis.Arsenical keratoses are rarely seen nowadays.Lichen striatus and epidermal nevi rarely involve the hand but may do so in a linear fashion.Papular mucinosis and acrokeratosis verruciformis may involve the dorsum of the hand.Erythema elevatum diutinum may be papular on the palms.Erythema multiforme will give characteristic iris lesions on the hands particularly the palms.

Very rare conditions such as multicentric reticulohistiocytosis can present as hand papules.

Grouped papules at the edges of hands and feet   Acrokeratoelastoidosis of Costa, Degenerative collagenous plaques of the hands, Keratoelastoidosis marginalis of the hands, Verruca plana, Acrokeratosis verruciformis of Hopf, Colloid milium, Xanthoma, and Punctate palmoplantar keratoderma.

Management  If you are not sure biopsy it.

SIGN DIP MEN   Overview of Papules

 

This is an extremely difficult area to give an all encompassing nemonic but  SIGN DIP LAPPIS can be used where L=Lichen etc,A=Adnexae,P=Pediculosis,P=Perforating diseases,I=Infiltrates xanthoma etc,and S=Syndromes Grover’s,Darier’s, Albopapuloid EB etc

 

It is probably best to view the differential diagnosis of papules in particular situations

Monomorphic micropapules in a group    Lichen nitidus,keratosis spinulosa,follicular eczema,follicular mucinosis,lichen scrofulosorum,sarcoidosis,lichen planus,keratosis pilaris

 

Polymorphic papules with necrosis     Pityriasis lichenoides , lymphomatoid papulosis, papulonecrotic tuberculid, perforating collagenosis, Wegener’s granuloma, allergic granulomatosis, leukocytoclastic vasculitis, insect bites, acne necrotica, acnitis.

 

Keratotic papules forming rings or arciform lesions   porokeratoses,perforating collagenoses,Kyrles disease,Elastosis perforans serpiginosa

 

Inflammatory papular dermatitis in children    Gianoti Crosti syndrome, Papular acral located syndrome, papular urticaria, scabies, frictional dermatitis, Bindii dermatitis, caterpillar hairs, mite bites, benign cephalic histiocytosis

 

Facial adnexal papules  Syringoma,trichoepithelioma,adenoma sebaceum,benighn cephalic histiocytosis,Cowden’s syndrome

 

Eyelid Papules   Milia,molluscum contagiosum,xanthoma,xanthogranuoma,amyloid,trichoepithelioma,Syringomas,acnitis,Cowden’s,Lipoid proteinosis,papular mucinosis

 

Multiple papules in the mouth    Cowdens,Darier’s,Goltz,florid oral papillomatosis,xanthoma disseminatum,reticulo histiocytosis,lipoid proteinosis,adenoma sebaceum,drugs,pyostomatitis vegetans,verrucous carcinoma

 

Acral papules   Warts,Gianotti-Crosti,Cowden’s,Multicentric reticulohistiocytosis,epidermodysplasia verruciformis,viral infection,scabies

 

Follicular Papules   Keratosis pilaris,lichen spinulosus,lichen planopilaris,Pityriasis rubra pilaris,lichen sclerosus,follicular mucinosis,discoid lupus erythematosus,vitamin d deficiency,fatty acid deficiency

SIGN DIP NIGL

N Nutritional Vit A,Vit C,essential fatty acid deficiency

I Infiltrates

G Genodermatoses Darier’s,Downs,Kyrles.

L Lichenoid