Several different types of dermatitis such as allergic and irritant contact dermatitis, atopic dermatitis and idiopathic dyshidrotic eczema may cause eczematous lesions on the hands and/ or feet.
Clinical picture:The clinical picture is varied. Erythema, scaling, small blisters on the palms/ soles, in the interdigital and periungual areas, papules on the backs of the hands/ feet, painful fissures and hyperkeratoses on the palms and/ or soles may be present. The lesions are mostly accompanied by moderate to severe pruritus.
Diagnosis:The diagnosis is based on careful history taking, clinical examination and possibly patch testing if allergies are suspected. Bacterial and mycological cultures may prove helpful in excluding superimposed infections. A skin biopsy may be useful to exclude other non-eczematous diseases.
Differential diagnoses:Besides distinguishing between the above-mentioned etiologic factors for eczema on the hands/ feet, the following non-eczematous diseases must also be taken into account depending on the clinical features: With hyperkeratosis and fissuring: Palmoplantar psoriasis, diffuse types of palmoplantar keratoderma, Olmsted syndrome and palmoplantar keratoses in Sézary syndrome are possible differential diagnoses. With vesicles, oozing or bullae: Pustular psoriasis of the palms and soles, epidermolysis bullosa hereditaria, hand-foot-mouth-disease, acrodermatitis enteropathica and scabies in children are possible differential diagnoses for vesicles on the palms and soles. With erythema on the dorsal hand and fingers: dermatomyositis and lupus erythematodes must be taken into account.