Differential Diagnosis for Fingertip Desquamation

• Single most likely diagnosis
  • Kawasaki Disease: A leading cause of fingertip desquamation in children, typically occurring in the subacute phase of the illness, around 2-3 weeks after the onset of fever. It's characterized by high fever, rash, swelling of hands and feet, conjunctivitis, and cervical lymphadenopathy.
• Other Likely diagnoses
  • Pediculosis (Lice Infestation): Can cause desquamation due to the intense scratching and subsequent skin reaction.
  • Dyshidrotic Eczema (Pompholyx): Characterized by small, itchy blisters on the palms or soles, which can lead to desquamation as they heal.
  • Psoriasis: Especially palmoplantar psoriasis, can cause desquamation of the fingertips due to the formation of thick, scaly plaques.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Toxic Shock Syndrome: Although rare, it can present with desquamation, particularly of the palms and soles, in its late stages. Early recognition is crucial due to its high mortality rate.
  • Staphylococcal Scalded Skin Syndrome (SSSS): Caused by staphylococcal toxins, it leads to widespread skin desquamation and can be life-threatening, especially in neonates and young children.
• Rare diagnoses
  • Keratolysis Exfoliativa (Lamellar Dyshidrosis): A rare condition characterized by recurrent episodes of desquamation of the palms and soles, often without an identifiable cause.
  • Pityriasis Rubra Pilaris (PRP): A rare skin disorder that can cause desquamation among other symptoms like reddish-orange patches and keratotic follicular papules.