Differential Diagnosis for Lesions on Palmer Surface and Dorsal Plantar Aspects of Feet
- Single most likely diagnosis:
- Erythema Multiforme (EM) - Characterized by targetoid lesions, often with a dark red center, which can appear on the palms, soles, and sometimes the dorsal aspects of hands and feet. The condition is usually triggered by infections or medications.
- Other Likely diagnoses:
- Fixed Drug Eruption - Presents with well-demarcated, circular patches that can have a dark center, often appearing on the palms, soles, and other areas. These lesions are typically a reaction to certain medications.
- Secondary Syphilis - Can manifest with a variety of skin lesions, including macules on the palms and soles, though these are not typically targetoid.
- Pityriasis Rosea - Although it doesn't typically present with targetoid lesions, it can cause a variety of skin manifestations, and in rare cases, lesions might appear on the palms and soles.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Rocky Mountain Spotted Fever (RMSF) - A severe tick-borne disease that can start with a maculopapular rash, which may appear on the palms and soles. The rash can evolve and may not always be present, but the disease is critical to diagnose early due to its high mortality rate if untreated.
- Meningococcemia - A severe infection caused by Neisseria meningitidis, which can present with a petechial or purpuric rash that may appear anywhere on the body, including the palms and soles. This condition is life-threatening and requires immediate medical attention.
- Rare diagnoses:
- Sweet Syndrome (Acute Febrile Neutrophilic Dermatosis) - Characterized by fever, neutrophilia, and tender, erythematous skin lesions, which can occasionally appear on the palms and soles. The lesions are not typically targetoid but can be part of a broader differential for atypical presentations.
- Leptospirosis - A zoonotic infection that can cause a wide range of symptoms, including skin manifestations. While not commonly associated with targetoid lesions on the palms and soles, it can present with a variety of skin findings in severe cases.