Differential Diagnosis for Rash on Hands and Feet with Pustular and Papules
Single Most Likely Diagnosis
- Palmoplantar Pustulosis (PPP): A chronic skin condition characterized by the formation of pustules on the palms and soles, often accompanied by papules. The condition's localized nature to the hands and feet, along with the presence of pustules and papules, makes it a strong candidate for the single most likely diagnosis.
Other Likely Diagnoses
- Dyshidrotic Eczema (Pompholyx): Characterized by small, itchy blisters on the hands and feet, which can evolve into pustules and papules. The condition's predilection for the hands and feet aligns with the symptoms described.
- Psoriasis (Palmoplantar Psoriasis): A form of psoriasis that affects the palms and soles, presenting with thickened skin, pustules, and papules. The involvement of the hands and feet, along with the specific skin manifestations, makes it a plausible diagnosis.
- Keratoderma Blennorrhagicum: Associated with reactive arthritis, it presents with pustular lesions on the palms and soles. Although less common, its specific involvement of the hands and feet warrants consideration.
Do Not Miss Diagnoses
- Gonococcal Infection: Can cause skin lesions, including pustules, on the hands and feet, especially in the context of disseminated gonococcal infection. Missing this diagnosis could lead to severe consequences, including sepsis and joint destruction.
- Syphilis (Secondary Syphilis): May present with a rash on the palms and soles, among other areas, and can include pustular and papular lesions. The potential for serious complications if left untreated makes it a critical diagnosis not to miss.
- Meningococcemia: Although rare, this condition can cause a rash that may include pustules and papules, and its rapid progression to sepsis and meningitis makes prompt recognition crucial.
Rare Diagnoses
- Pityriasis Rubra Pilaris (PRP): A rare skin disorder that can present with palmoplantar keratoderma, pustules, and papules, among other skin manifestations. Its rarity and varied presentation make it less likely but still a consideration in the differential diagnosis.
- Acropustulosis: A rare condition characterized by recurrent pustular eruptions on the hands and feet. Its specific involvement of the hands and feet, although rare, aligns with the symptoms described.