Hands and Feet Red Scaly

Red scaly rashes on the Hands and Feet

The common red scaly rashes on the hands and feet are Psoriasis,Tinea manum and Irritant or Contact dermatitis.Psoriasis on the palms and soles presents as a keratoderma while the more typical red scaly plaque is seen on the back of the hands.Tinea on the hands and feet presents as a spreading red scaly rash on the dorsal surfaces but as a fine scaling rash on the palms and soles typically due to Trichophyton rubrum infection..Watch for the two soles one palm presentation.Tinea infections of the hand may be unilateral while psoriasis and dermatitis are usually bilateral and symmetrical.Scabies may present as an itchy red scaly rash on the hands involving the web spaces with burrows of the scabies mite clearly visible.Secondary syphilis looks like pityriasis rosea on the trunk but you have these red scaly lesions on the palms as well.

Management  Scrape any scaly rash on the hands and feet for fungus,culture nails if involved as well,and using a KOH preparation look for scabies mites.If there is fissuring and oozing and the hands are very itchy it is likely to be a dermatitis.

SIGN DIP MEN     Overview of Red scaly diseases

 

S-Squamous      Psoriasis,Atopic eczema,Contact eczema,Seborrhoeic eczema,Pityriasis rosea,Pityriasis lichenoides,Pityriasis versicolor,Pityriasis rubra pilaris,Darier’s disease,Lichen planus,Erythrokeratoderma,Exfoliative dermatitis,Congenital ichthyosiform erythroderma,Lamellar ichthyosis,Epidermolytic hyperkeratosis,

 

I-Infective     Tinea corporis,Secondary syphilis,Tuberculosis,Leprosy,Leishmaniasis,Candidiasis

 

G-Granulomatous  Sarcoidosis 

 

N-Neoplastic    Superficial bcc and scc,Parapsoriasis,Mycosis fungoides,Sezary syndrome,Disseminated actinic porokeratoses,

 

D-Drugs  Exfoliative dermatitis eg gold,

 

I-Immunological   Discoid lupus erythematosus,Pemphigus foliaceous,Chronic actinic dermatitis

 

P-Physical     Sunburn,Scabies,Perforating disorders,

 

M-Metabolic  Glucagonoma syndrome,

 

E-Endocrine   

 

N-Nutritional      Pellagra, Acrodermatitis enteropathica,Kwashiokor,

 

Others   Ilven,

 

 

Keratoderma of the palms and soles of the hands and feet.

This is a massive topic with many congenital named forms and some characteristic patterns.However if aquired and on the central palms and around the outer heels always consider psoriasis.Aquired keratoderma can also be part of Pityriasis rubra pilaris but it is generally a late feature of the disease.Then consider underlying malignancy particularly stomach and oesophagus.If very itchy and thick scales remember crusted scabies and on the feet remember tinea rubrum or mocasson tinea.Keratoderma climactericum is probably the commonest cause in females.

The following reference from eMedicine discusses all the congenital variants of palmoplantar keratoderma.