Differential Diagnosis for Pediatric Palms Rash
Single Most Likely Diagnosis
- Kawasaki Disease: A leading cause of acquired heart disease in children, characterized by fever, rash, conjunctivitis, and changes to the lips and oral cavity, with a distinctive rash that can include the palms.
Other Likely Diagnoses
- Hand, Foot, and Mouth Disease (HFMD): A common viral illness in children, caused by coxsackievirus or enterovirus, presenting with a rash on the palms and soles, along with fever and oral ulcers.
- Impetigo: A bacterial skin infection that can cause a rash on the palms, often accompanied by honey-colored crusts and pus-filled blisters.
- Scabies: A parasitic infection causing intense itching and a pustular rash, which can involve the palms, especially in infants.
Do Not Miss Diagnoses
- Staphylococcal Scalded Skin Syndrome (SSSS): A severe condition caused by staphylococcal toxins, leading to widespread skin exfoliation and can start with a localized rash, including on the palms. It's life-threatening and requires immediate treatment.
- Toxic Epidermal Necrolysis (TEN): A severe skin condition usually triggered by medications, leading to widespread skin necrosis and detachment. It can start with a rash on the palms and soles and is potentially fatal.
- Child Abuse: Certain patterns of injury, including burns or bruises on the palms, can be indicative of child abuse, which is critical to identify for the child's safety.
Rare Diagnoses
- Pityriasis Rubra Pilaris (PRP): A rare skin disorder characterized by salmon-colored patches, palmoplantar keratoderma, and sometimes a rash on the palms.
- Keratoderma Blennorrhagicum: Associated with reactive arthritis, it presents with a rash on the palms and soles, among other symptoms.
- Secondary Syphilis: Can cause a rash on the palms and soles, among other areas, and is a rare but important diagnosis due to its implications for treatment and prevention of further complications.