Differential Diagnosis
- Single most likely diagnosis
- Eczema (Dyshidrotic): The description of deep white patches, swelling, and a burning sensation on the fingers, particularly where the pad meets the nail bed, is consistent with dyshidrotic eczema. This condition often presents with small, itchy blisters or patches on the hands and feet.
- Other Likely diagnoses
- Psoriasis: The separation of the nail bed from the nail and the presence of white patches could also suggest psoriasis, especially if there's a history of psoriatic lesions elsewhere on the body.
- Contact Dermatitis: An allergic reaction or irritant contact dermatitis could cause similar symptoms, especially if the individual has recently been exposed to new substances or products that come into contact with their hands.
- Fungal Infection (Onychomycosis): While more commonly associated with changes in the nail itself, fungal infections can sometimes cause inflammation and separation of the nail from the nail bed, along with discomfort.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Infectious Flexor Tenosynovitis: This is a serious infection of the tendon sheaths in the hand that can cause pain, swelling, and decreased mobility. Although less likely given the description, it's crucial to consider due to its potential for severe consequences if not promptly treated.
- Osteomyelitis or Septic Arthritis: While rare, infections of the bone or joints in the fingers could present with localized pain, swelling, and redness. These conditions are medical emergencies.
- Rare diagnoses
- Sclerodactyly (Limited Systemic Sclerosis): This condition involves tightening of the skin on the fingers, which can lead to limited movement and could potentially cause discomfort or changes in the nail bed area, though it's less likely given the acute presentation.
- Raynaud’s Phenomenon: This condition causes some areas of your body — such as your fingers and toes — to feel numb and cold in response to cold temperatures or stress. It could potentially lead to localized ischemia and tissue changes, but the primary symptoms described don't directly align with Raynaud's.