Differential diagnoses: Hand rashes

Four presentations of hand rashes and clues for their diagnosis, including atopic dermatitis and pompholyx. By Dr Nigel Stollery.

Atopic dermatitis

Presentation

  • Chronic itchy skin condition
  • Can occur at any age, but less common with increasing age
  • Associated with other atopic conditions, such as asthma, hay fever and rhinitis
  • Often a genetic component
  • Underlying problem is a defect in skin barrier function
  • Stress, viruses and teething in babies common triggers
  • Secondary infection common

Management

  • Emollients are mainstay, but avoidance of triggers important
  • Topical steroids or immunosuppressants usually required
  • Severe cases may require second-line oral therapy

Irritant contact dermatitis

Presentation

  • Eczematous reaction that can occur anywhere on the body when chemicals or physical damage injure skin faster than it can repair itself
  • Severity related to exposure, strength of irritant, environmental factors and individual susceptibility
  • Can affect anyone

Management

  • Specific tests not usually required
  • Management aims to reduce contact with irritants
  • Emollients, topical steroids can be helpful once dermatitis has developed
  • If secondary infection, antibiotics may be required

Allergic contact dermatitis

Presentation

  • Allergic dermatitis secondary to contact with a specific allergen
  • Reaction usually only where contact has occurred
  • Recurrent reaction secondary to each exposure
  • Can affect anywhere on the body; in this case, allergen was latex
  • May occur hours after exposure
  • Affected areas commonly itchy, red and swollen; may blister

Management

  • Patch testing can be useful in identifying allergens
  • Mainstay is avoiding allergens
  • Once dermatitis develops, emollients and topical steroids can help

Pompholyx

Presentation

  • Common type of eczema, affects hands and feet
  • Flares more common in hot weather or at times of stress
  • Can follow fungal infection
  • Occurs as deep-seated crops of blisters
  • Usually associated with burning sensation and intense pruritus

Management

  • Includes cool compresses
  • Emollients can be helpful
  • Potent topical steroids usually required
  • In severe cases, psoralen-UVA or systemic steroids may help
  • In chronic cases, methotrexate, dapsone or azathioprine may help

Dr Stollery is a GP in Leicestershire

Click here to take a test on this article and claim your certificate on MIMS Learning

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

RCGP criticises GP at Hand video showing antibiotics prescribed for sore throat

RCGP criticises GP at Hand video showing antibiotics prescribed for sore throat

A promotional video for Babylon GP at Hand that shows a patient with a sore throat...

Submit your session ideas for the RCGP Annual Conference 2019

Submit your session ideas for the RCGP Annual Conference 2019

GPs can now submit ideas for sessions at the RCGP Annual Conference in Liverpool,...

Scottish GP workforce increases for first time in 10 years, figures show

Scottish GP workforce increases for first time in 10 years, figures show

GP numbers in Scotland have risen slightly for the first time in 10 years despite...

More than 16m GP practice appointments a year lost to DNAs

More than 16m GP practice appointments a year lost to DNAs

More than 16m appointments at GP practices are lost every year because patients fail...

Six ways GPs can help patients with asthma to stay well this winter

Six ways GPs can help patients with asthma to stay well this winter

Up to 26,000 people could be hospitalised with asthma this winter. GP and Asthma...

Red flag symptoms: Hirsutism

Red flag symptoms: Hirsutism

There are a number of possible causes for this symptom, explains Dr Pipin Singh