What is the treatment for a red swollen irritated palm?

Treatment for Red Swollen Irritated Palm

For a red swollen irritated palm, treatment should include a topical moderate-potency corticosteroid applied twice daily along with regular application of fragrance-free moisturizers containing petrolatum or mineral oil. 1

Initial Assessment

When evaluating a red swollen irritated palm, consider these potential causes:

• Contact dermatitis (irritant or allergic)
• Hand-foot skin reaction (HFSR) from medications
• Palmar-plantar erythrodysesthesia syndrome (PPES)
• Infection (bacterial, fungal, viral)

Treatment Algorithm

Step 1: Basic Care and Irritant Avoidance

• Wash hands with lukewarm water and soap-free cleansers 1
• Pat dry gently instead of rubbing 1
• Apply fragrance-free moisturizer immediately after washing 1
• Avoid irritants: harsh soaps, hot water, chemical irritants 1

Step 2: Anti-inflammatory Treatment

• Apply mid-potency topical corticosteroid twice daily 1
  • For moderate cases: mid-potency corticosteroids
  • For severe cases: higher potency corticosteroids (e.g., mometasone furoate)
  • Avoid continuous use of high-potency corticosteroids like clobetasol for extended periods due to risk of skin atrophy 2

Step 3: Barrier Repair

• Apply moisturizer at least 2 fingertip units to each hand 1
• Reapply every 3-4 hours and after each hand washing 1
• Choose cream formulations for better hydration than lotions 1
• For extremely dry skin, use ointment-based products 1

Step 4: For Suspected Infection

• If infection is suspected, obtain bacterial/viral/fungal cultures 3
• Consider oral antibiotics for 6 weeks (options include): 3
  • Doxycycline 100 mg twice daily
  • Minocycline 50 mg twice daily
  • Oxytetracycline 500 mg twice daily

Special Considerations

If Medication-Induced

If the irritation is related to chemotherapy or targeted therapy medications (PPES/HFSR):

• Continue medication at current dose unless severe 3
• Apply topical corticosteroids twice daily 3
• Consider systemic corticosteroids for severe cases (prednisone 0.5-1 mg/kg for 7 days) 3
• Reassess after 2 weeks; if worsening, dose interruption may be necessary 3

For Prevention

• Cotton glove liners under work gloves can reduce irritation 1
• Rotate tasks to minimize continuous irritant exposure 1
• Apply moisturizer at least once daily, twice daily for moderate to severe dryness 1

Follow-up and Treatment Adjustment

• Reassess after 2 weeks of treatment 1
• If no improvement:
  • Consider patch testing if allergic contact dermatitis is suspected 1
  • Escalate to more potent corticosteroids if needed 1
  • Consider alternative therapies like tacrolimus 0.1% for sensitive areas 1

Cautions

• Avoid using topical corticosteroids continuously for extended periods due to risk of skin atrophy 2, 4
• Children may absorb proportionally larger amounts of topical corticosteroids and be more susceptible to systemic toxicity 2
• If the inflammatory lesion becomes infected, appropriate antifungal or antibacterial agents should be instituted 2
• Certain areas like the face, groin, and axillae are more prone to atrophic changes from corticosteroids 2

By following this treatment approach, most cases of red swollen irritated palms should show improvement within 1-2 weeks of appropriate treatment 1.