Differential Diagnosis for a 2-year-old with a Rash on the Right Hand and Wrist
Single Most Likely Diagnosis
- Contact Dermatitis: This is a common condition in children, often caused by exposure to irritants or allergens such as soap, detergent, or certain plants. The location on the hand and wrist is typical for contact dermatitis, especially if the child has been playing outdoors or with new toys.
Other Likely Diagnoses
- Eczema (Atopic Dermatitis): A chronic skin condition characterized by dry, itchy, and inflamed skin. It often starts in childhood and can appear on the hands and wrists.
- Impetigo: A contagious bacterial skin infection that can cause red sores or blisters, often on the face but can spread to other areas including the hands.
- Insect Bites or Stings: Mosquito bites, ant bites, or other insect stings can cause localized rashes and itching on the hands and wrists.
Do Not Miss Diagnoses
- Cellulitis: A bacterial skin infection that can cause redness, swelling, and warmth of the skin. It requires prompt antibiotic treatment to prevent serious complications.
- Herpes Simplex Virus (HSV) Infection: Although less common on the hands, HSV can cause painful blisters. In children, it might be a result of autoinoculation from an oral lesion.
- Scabies: A parasitic infection caused by the scabies mite, leading to intense itching and a pimple-like skin rash. It can spread to any part of the body, including the hands.
Rare Diagnoses
- Kawasaki Disease: An acute febrile illness that predominantly affects children, characterized by fever, rash, swelling of hands and feet, and other systemic symptoms. The rash can appear on the hands and wrists among other areas.
- Pityriasis Rubra Pilaris (PRP): A rare skin disorder that causes constant itching and scaling (exfoliation) of the skin. It can start with a reddish-orange patch on the skin, potentially on the hands.
- Dyshidrotic Eczema (Pompholyx): A type of eczema that specifically affects the hands and feet, characterized by small, itchy blisters. It's less common in young children but can occur.