Differential Diagnosis
- Single most likely diagnosis
- Pityriasis versicolor: This condition is characterized by white spots on the face and hands, which can increase in number over time. It's not typically itchy, although some patients may experience mild itching. The presence of a different rash on the hands that is itchy could be a separate condition or a variation in the presentation of pityriasis versicolor.
- Other Likely diagnoses
- Vitiligo: This is an autoimmune condition that causes white patches on the skin due to the loss of pigment-producing cells. It can start with one patch and increase in number over time. It's not typically itchy.
- Eczema (atopic dermatitis): Although the patient denies itchiness on the face, the itchy rash on the hands could be eczema. Eczema can present with different types of rashes and varying levels of itchiness.
- Contact dermatitis: This could explain the itchy rash on the hands if the patient has come into contact with an allergen or irritant. The lack of itchiness on the face might suggest a different condition or a variation in sensitivity.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Leprosy (Hansen's disease): Although rare and unlikely, leprosy can cause skin lesions and nerve damage. Early diagnosis is crucial for effective treatment. The absence of joint pain, cough, or sore throat does not rule out leprosy, as these symptoms are not always present.
- Sarcoidosis: This is a condition that can affect multiple parts of the body, including the skin, lungs, and joints. Skin manifestations can be varied and might include rashes or lesions. Although the patient denies systemic symptoms like cough or joint pain, sarcoidosis can be asymptomatic in its early stages.
- Rare diagnoses
- Idiopathic guttate hypomelanosis: This is a rare condition characterized by small, white spots on the skin, typically on the arms and legs, but can appear on the face and hands. It's not usually itchy.
- Progressive macular hypomelanosis: A rare condition causing hypopigmented patches, mainly on the trunk, but can appear on the face. It's not typically itchy.