Differential Diagnosis for Isolated Small Blisters of Palms with Small Amount of Thick Pus

• Single Most Likely Diagnosis
  • Dyshidrotic Eczema (Pompholyx): This condition is characterized by the appearance of small, itchy blisters on the palms or soles, often filled with a thick, pus-like fluid. It's a common condition that matches the description closely.
• Other Likely Diagnoses
  • Bacterial Infections (e.g., Staphylococcus aureus, Streptococcus pyogenes): These can cause localized infections leading to pus-filled blisters, especially if there's a break in the skin.
  • Herpes Simplex Virus Infection: Although more commonly associated with oral or genital areas, herpes simplex can cause herpetic whitlow, which presents as painful, pus-filled blisters on the fingers or palms.
  • Fungal Infections: Certain fungal infections, like those caused by dermatophytes, can lead to blistering lesions on the palms, though they are less common.
• Do Not Miss Diagnoses
  • Gonococcal Infection: A sexually transmitted infection that can cause skin lesions, including pus-filled blisters, especially in the context of disseminated gonococcal infection.
  • Syringomyelia: A neurological condition where a fluid-filled cavity forms within the spinal cord, potentially leading to loss of pain sensation and subsequent unnoticed injuries or infections, which could present as blisters or ulcers on the palms.
• Rare Diagnoses
  • Pustular Psoriasis: A rare form of psoriasis that can cause pus-filled blisters, though it typically involves more than just the palms and is accompanied by other psoriatic lesions.
  • Acropustulosis: A rare condition characterized by recurrent, sterile pustules on the palms and soles, often associated with other systemic diseases.
  • Erythema Multiforme: An immune-mediated condition that can cause target-like lesions and, in some cases, blistering, including on the palms, though it's more commonly associated with mucosal involvement and other skin manifestations.