Differential Diagnosis for Rash over Palms and Soles in Children
Single Most Likely Diagnosis
- Hand, Foot, and Mouth Disease (HFMD): This is a common viral illness in children, characterized by a rash on the palms and soles, along with mouth sores. It's highly contagious and usually caused by coxsackievirus A or enterovirus 71.
Other Likely Diagnoses
- Kawasaki Disease: An acute febrile illness that can present with rash, including on the palms and soles, along with other symptoms like fever, conjunctivitis, and lymphadenopathy. It's an important diagnosis to consider due to its potential for cardiac complications.
- Scarlet Fever: Caused by group A beta-hemolytic streptococci, it presents with a rash that can appear on the palms and soles, accompanied by fever, pharyngitis, and a characteristic "strawberry tongue."
- Erythema Infectiosum (Fifth Disease): Although the rash typically starts on the face, it can spread to the palms and soles. It's caused by parvovirus B19 and is usually mild.
Do Not Miss Diagnoses
- Secondary Syphilis: Can present with a rash on the palms and soles, which is a distinctive feature. Given the potential for severe complications if left untreated, it's crucial not to miss this diagnosis.
- Meningococcemia: A severe infection caused by Neisseria meningitidis, which can present with a petechial or purpuric rash that may appear on the palms and soles. It's a medical emergency due to the risk of sepsis and meningitis.
- Rocky Mountain Spotted Fever (RMSF): A tick-borne illness that can cause a rash on the palms and soles, along with fever and headache. It's critical to diagnose promptly due to the risk of severe disease if not treated early.
Rare Diagnoses
- Pittsburgh Pox (Pittsburgh Pox Virus): A rare condition that could present with rash, though it's less commonly associated with palms and soles.
- Enteroviral infections other than HFMD: Other enteroviruses can cause rashes, though they are less common and might not typically present with palm and sole involvement.
- Idiopathic diseases like Gianotti-Crosti syndrome: A rare condition characterized by a rash that can appear on the face, arms, and legs, and sometimes the palms and soles, often associated with hepatitis B or other viral infections.