Differential diagnoses: Conditions of the hands

Dr Nigel Stollery compares four presentations and offers clues for their diagnosis including vasculitis, erythema multiforme, cutaneous lupus erythematosus, palmar erythema.

Vasculitis

Presentation

  • Rare condition, in which there is inflammation of blood vessels
  • 3,000 cases in the UK per year
  • Can be primary or secondary
  • 45% idiopathic, 20% secondary to infection, 15% drug induced
  • May be associated with systemic symptoms, such as arthralgia and lethargy

Management

  • Skin biopsy can be useful if differentiating between types
  • Investigations aimed at finding underlying cause, which directs treatment
  • Urinalysis can be helpful in detecting renal involvement
  • Immunosuppressants may be required in the longer term
  • Newer biologicals also helpful

Erythema multiforme

Presentation

  • Hypersensitivity reaction with trigger, such as herpes simplex infection
  • Rash forms target or iris lesions
  • May affect mucus membranes
  • Acute onset most commonly in young adults aged 20-40 years
  • Usually self limiting
  • May recur following further herpes outbreaks

Management

  • If diagnosis in doubt, skin biopsy can be helpful
  • Symptomatic treatment with antihistamines, analgesia
  • Rash usually clears in two to three weeks without scarring
  • In recurrent cases associated with herpes simplex, daily aciclovir can be helpful

Cutaneous lupus erythematosus

Presentation

  • Most commonly affects women aged 20-50 years
  • Autoimmune condition
  • Often exacerbated by UV light
  • May be more severe in smokers
  • Often leaves postinflammatory hyperpigmentation
  • May be localised or widespread
  • Often leaves scars
  • Other affected areas include face, neck and rarely, palms
  • May cause scarring alopecia

Management

  • Treatment includes topical steroids, calcineurin inhibitors, antimalarials, oral steroids
  • Avoiding UV light is important
  • Camouflage can be helpful

Palmar erythema

Presentation

  • Reddening of palms and fingers
  • Combination of underlying processes, including increased cardiac output, localised inflammation, capillary dilation and high cord estrogen levels
  • Seen in 30% of pregnant women, 23% of patients with cirrhosis, 60% of patients who have rheumatoid arthritis
  • Associated with certain drugs, smoking, polycythaemia, sarcoidosis, systemic lupus erythematosus

Management

  • No specific treatment
  • May improve when underlying condition is treated
  • Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Second-phase COVID-19 vaccine rollout maintains prioritisation by age

Second-phase COVID-19 vaccine rollout maintains prioritisation by age

The Joint Committee on Vaccination and Immunisation (JCVI) has published advice on...

PCNs paid £70m for first-wave COVID-19 jab campaign as NHS plots next phase of rollout

PCNs paid £70m for first-wave COVID-19 jab campaign as NHS plots next phase of rollout

Primary care network (PCN) COVID-19 vaccination sites have been paid £70m this month...

UK COVID-19 vaccination programme tracker

UK COVID-19 vaccination programme tracker

GPs across the UK are playing a leading role in the largest-ever NHS vaccination...

London GP personally calling at-risk patients to boost COVID-19 vaccine uptake

London GP personally calling at-risk patients to boost COVID-19 vaccine uptake

London GP Dr Farzana Hussain is personally telephoning scores of patients who have...

Half of patients with possible cancer symptoms avoided contacting GP in first wave

Half of patients with possible cancer symptoms avoided contacting GP in first wave

Almost half of people who experienced potential cancer symptoms in the first wave...

GP premises need major investment to let PCNs recruit, warns BMA

GP premises need major investment to let PCNs recruit, warns BMA

Primary care networks (PCNs) are struggling to make use of hundreds of millions of...