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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: June 17, 2025 • View editorial policy

Differential Diagnosis for Infectious Reasons for Rash on the Palms

Single Most Likely Diagnosis

  • Secondary Syphilis: This is often considered the most likely diagnosis for a rash on the palms due to its classic presentation of a maculopapular rash on the palms and soles, among other symptoms. Secondary syphilis is a systemic infection caused by the bacterium Treponema pallidum, and the rash on the palms is a hallmark, although not exclusive, feature.

Other Likely Diagnoses

  • Hand, Foot, and Mouth Disease (HFMD): Caused by viruses such as Coxsackievirus A or Enterovirus 71, HFMD presents with vesicular lesions on the palms and soles, along with oral ulcers. It's highly contagious and common in children but can also occur in adults.
  • Palmoplantar Eczema (Dyshidrotic Eczema): While not strictly an infectious disease, it can be exacerbated by or coexist with fungal infections. It presents with small, itchy blisters on the palms and soles.
  • Scabies: Caused by the mite Sarcoptes scabiei, scabies can lead to a rash on the palms, especially in infants. The rash is usually accompanied by intense itching.

Do Not Miss Diagnoses

  • Primary Syphilis: Although the primary stage of syphilis is characterized by a chancre at the site of infection, in rare cases, it can present with a rash on the palms. Missing this diagnosis could lead to untreated syphilis, which can progress to more severe stages.
  • Hansen's Disease (Leprosy): Leprosy can cause skin lesions, including on the palms, and is critical not to miss due to its potential for causing permanent nerve damage and disability if left untreated.

Rare Diagnoses

  • Kawasaki Disease: This rare condition, mostly seen in children, can present with a rash on the palms and soles, among other symptoms like fever, conjunctivitis, and lymphadenopathy. It's an important diagnosis to consider due to its potential for causing coronary artery aneurysms.
  • Idiopathic Erythema Multiforme: A skin condition characterized by target lesions, which can appear on the palms. It can be triggered by infections, among other factors, and while rare, its appearance on the palms could be a diagnostic clue.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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