Hands and Feet Pustules

Pustules on the hands   are usually due to infected pompholx eczema especially if on the sides of the fingers and the palms.Usually these vesicles are clear fluid filled at first before becoming pustular.Lesions that are primarily pustules from the beginning may be localised pustular psoriasis.The pustules will be sterile on culture.Staph folliculitis and Tinea manum are usually on the dorsum of the hands and both may involve hair follicles.Remember rarer pustular problems such as Orf or localised herpes simplex in dental assistants.In children under one pustules on the palms and soles may be a feature of scabies.

Management   Always culture for bacteria and viruses and take skin scrapings for fungus.Biopsies seldom help in pustular disorders on the hands.

SIGN DIP MEN  Overview of Pustules

 

S-Squamous    Tinea corporis(edge), Pustular Psoriasis, Subcorneal pustular dermatosis, localised pustular psoriasis, Reiter’s syndrome, Pleva,

 

I-Infective     Herpes simplex(grouped), Staph Folliculitis, Pseudomonas folliculitis, Acne vulgaris, Rosacea, Gonnococcemia, Chickenpox, Infected pompholyx eczema, Impetigo, Infected scabies, Ecthyma, Candidiasis(satellite pustules), Anthrax, Rarely secondary syphilis, Fungal septicemia due to candida, mucor or Cryptococcus, Hand foot and mouth disease, Kaposi’s varicelliform eruption

 

G-Granulomatous  Rosacea

 

N-Neoplastic

 

D-Drugs     Iodides and Bromides, Steroids, Norfloxacin, Frusemide, Cotrimoxazole, Fixed pustular drug eruption due to Amoxycillin, Antiepileptics and sulfonamides cause toxic pustuloderma.

 

I-Immunological  Variant of Dermatitis herpetiformis, Eosinophilic pustular folliculitis, Intestinal bypass dermatitis, Localised pustular vasculitis in rheumatoid arthritis, Impetigo herpetiformis, Sweet’s syndrome

 

P-Physical     Miliaria pustulosa, Swimmer’s itch,

 

M-Metabolic  Acrodermatitis enteropathica,

 

E-Endocrine

 

N-Nutritional  Acrodermatitis enteropathica

 

Others

Scalp Pustules  Bacterial infection, Dermatophytes, Dissecting cellulitis, Folliculitis decalvans, Traction alopecia at the edge, Erosive pustular dermatosis,

 

Generalised Pustulosis   Psoriasis, Impetigo herpetiformis, Herpes simplex, Candidiasis, Chickenpox, Scabies, Infected dermatitis, Drugs, Darier’s disease

 

Pustular Vasculitis   Behcet’s, Bowel associated dermatosis, Arthritic vasculitis, Primary cutaneous pustular vasculitis, Disseminated neiserial infections, Acute generalised pustular bacterid