Differential Diagnosis for Redness of the Hands

The patient's symptoms of redness on the dorsal side of the hands, accompanied by burning and numbness, and the history of handling chemicals without gloves, suggest several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Irritant Contact Dermatitis: This is the most likely diagnosis given the patient's exposure to chemicals without protective gloves. The symptoms of redness, burning, and numbness are consistent with an irritant reaction to the chemicals.

• Other Likely Diagnoses

  • Allergic Contact Dermatitis: Although less likely than irritant contact dermatitis, allergic contact dermatitis is a possibility, especially if the patient has developed an allergy to one of the chemicals being handled. Symptoms can be similar to irritant contact dermatitis but typically require a sensitization period.
  • Chemical Burns: Direct contact with harsh chemicals can cause burns, leading to redness, pain, and potentially numbness due to damage to the skin and nerves.

• Do Not Miss Diagnoses

  • Systemic Toxicity from Chemical Exposure: Certain chemicals can cause systemic toxicity through skin absorption, leading to neurological symptoms like numbness, among others. Missing this diagnosis could lead to severe health consequences.
  • Peripheral Neuropathy: Exposure to certain toxins can cause peripheral neuropathy, characterized by numbness, tingling, and burning sensations in the hands. This is a critical diagnosis not to miss due to its implications for long-term nerve damage.

• Rare Diagnoses

  • Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet. While it could be considered in the differential, it is less likely given the direct exposure to chemicals.
  • Complex Regional Pain Syndrome (CRPS): A condition characterized by severe, burning pain at the site of an injury, which could potentially be triggered by chemical exposure. It is rare and would be an unusual first consideration without a clear history of trauma.