Differential Diagnosis for Scaly Blistering of Palms and Soles with Pruritic Sensation

• Single Most Likely Diagnosis

  • Dyshidrotic Eczema (Pompholyx): This condition is characterized by the appearance of small, itchy blisters on the palms and soles, often accompanied by a scaly appearance. The pruritic sensation and the specific locations of the blisters make dyshidrotic eczema a leading consideration.

• Other Likely Diagnoses

  • Contact Dermatitis: This is a type of inflammation of the skin that occurs when the skin comes into contact with an irritant or allergen, leading to symptoms like redness, itching, and small blisters. Given the scaly and blistering presentation, especially if the patient has been exposed to new substances, contact dermatatitis is a plausible diagnosis.
  • Psoriasis: While psoriasis more commonly affects the elbows, knees, and scalp, it can also present on the palms and soles, leading to scaly, blistering lesions. The pruritic sensation can also be a feature of psoriasis, making it another likely diagnosis.
  • Pustular Psoriasis: A rare type of psoriasis that can cause white pustules on the palms and soles, surrounded by red, scaly skin. It's less common but should be considered due to its specific involvement of the palms and soles.

• Do Not Miss Diagnoses

  • Pemphigus Vulgaris: An autoimmune disease that can cause severe blistering of the skin and mucous membranes. Although less common, missing this diagnosis could lead to severe complications, including significant morbidity and mortality.
  • Staphylococcal Scalded Skin Syndrome (SSSS): Caused by staphylococcal toxins, SSSS leads to widespread blistering and peeling of the skin, which can start on the face and spread. It's more common in children but can occur in adults, especially those with compromised immune systems.
  • Toxic Epidermal Necrolysis (TEN): A severe skin condition usually triggered by medications, leading to widespread skin necrosis and detachment. It's a medical emergency and must be considered in any patient with widespread skin blistering and peeling.

• Rare Diagnoses

  • Keratoderma Blennorrhagicum: A rare condition associated with Reiter's syndrome, characterized by the appearance of vesicles and pustules on the palms and soles that eventually become hyperkeratotic.
  • Acropustulosis: A rare condition that can cause recurrent crops of pustules on the palms and soles, often accompanied by desquamation and sometimes associated with other autoimmune conditions.