What are the differential diagnoses for a symmetrical blanchable rash on the hands?

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Differential Diagnosis for Symmetrical Blanchable Hand Rash

  • Single most likely diagnosis
    • Erythema multiforme: This condition is characterized by symmetrical, blanchable rashes often on the hands and feet, and is commonly triggered by infections or medications.
  • Other Likely diagnoses
    • Contact dermatitis: A common condition caused by skin contact with an allergen or irritant, leading to a blanchable rash that can be symmetrical if exposure is bilateral.
    • Psoriasis: Although typically non-blanchable due to its characteristic scaling, early stages or certain types like guttate psoriasis might present with blanchable lesions and can be symmetrical.
    • Dyshidrotic eczema: Characterized by small, itchy blisters on the hands and feet, which can appear symmetrical and may initially present with blanchable rashes.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN): Although these conditions typically present with non-blanchable lesions due to epidermal detachment, early stages might be blanchable. They are life-threatening and require immediate medical attention.
    • Kawasaki Disease: An acute febrile illness that can present with symmetrical rash, among other criteria. It's crucial to diagnose early to prevent cardiac complications.
  • Rare diagnoses
    • Scleroderma: A chronic autoimmune disease that can cause skin thickening and tightening, potentially leading to symmetrical changes on the hands, though it's less likely to present as a blanchable rash.
    • Systemic Lupus Erythematosus (SLE): A systemic autoimmune disease that can cause a variety of skin manifestations, including rashes that might be symmetrical and blanchable, though this is less common.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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