Differential Diagnosis for Painful Vesicular Rash on Soles of Both Feet
- Single Most Likely Diagnosis
- Hand, Foot, and Mouth Disease (HFMD): This is a common viral illness that typically affects children but can also occur in adults. It is characterized by a vesicular rash on the hands and feet, along with oral ulcers. The involvement of the soles of both feet with a painful vesicular rash makes HFMD a strong consideration, especially in the context of exposure to others with similar symptoms or in outbreaks.
- Other Likely Diagnoses
- Contact Dermatitis: This condition can cause a vesicular rash due to an allergic reaction or irritant exposure. If the rash is limited to the soles of the feet, potential allergens or irritants that come into contact with this area should be considered.
- Dyshidrotic Eczema (Pompholyx): Characterized by small, itchy blisters on the hands or feet, dyshidrotic eczema could present with painful vesicles, especially if secondarily infected.
- Herpes Simplex Virus (HSV) Infection: Although less common on the soles, HSV can cause painful vesicular lesions anywhere on the skin, including the feet, especially in immunocompromised individuals or as part of a primary infection.
- Do Not Miss Diagnoses
- Varicella-Zoster Virus (VZV) Infection: While shingles typically presents as a unilateral rash, in immunocompromised patients, it can disseminate and involve multiple dermatomes, including the feet. Missing this diagnosis could lead to severe complications.
- Toxic Epidermal Necrolysis (TEN) or Stevens-Johnson Syndrome (SJS): These are severe skin conditions usually triggered by medications. They can start with a vesicular rash and progress to widespread skin necrosis and detachment, which is life-threatening.
- Rare Diagnoses
- Pemphigus Vulgaris: An autoimmune disease causing blistering of the skin and mucous membranes. It's rare but could present with painful vesicles on the feet among other areas.
- Bullous Pemphigoid: Another autoimmune blistering disease that can present with large blisters on various parts of the body, including the feet, though it's less common in this location.
- Erythema Multiforme: A skin condition characterized by target lesions, which can sometimes appear vesicular. It's often related to infections or medications and can be localized or widespread.