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

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