What is the cause of and how to manage itching on the palms and soles of a 23-year-old patient with no comorbidities, who recently swam in cold weather, had a fever, and did not respond to paracetamol and cetirizine?

Kati ng Palad at Talampakan Pagkatapos ng Lagnat

Ang pinaka-malamang na dahilan ay post-viral dyshidrotic eczema o hand-foot eczema, at dapat magsimula ng potent topical corticosteroid (clobetasol 0.05%) kasama ng urea cream para sa sintomas na hindi gumaling sa cetirizine. 1

Mga Life-Threatening na Dapat Agad Alisin

Kahit walang lagnat ngayon, kailangan mong i-rule out ang mga seryosong kondisyon:

• Rocky Mountain Spotted Fever (RMSF) - Ang CDC ay nagsasabing dapat mag-empiric doxycycline kaagad kung may kasama pang lagnat, sakit ng ulo, o systemic symptoms, dahil 50% ng deaths ay nangyayari within 9 days 2, 3
• Pero sa case mo, wala nang lagnat at ang kati lang ang sintomas, kaya malabong RMSF ito 2
• Intrahepatic cholestasis - Pero hindi ka buntis based sa edad at walang mention, kaya hindi applicable 1

Pinaka-Malamang na Diagnosis

Ang clinical picture mo ay classic para sa post-viral dyshidrotic eczema o hyperkeratotic hand-foot eczema:

• Nagsimula pagkatapos ng viral illness (lagnat after swimming in cold weather) 4
• Matinding kati ng palms at soles 4
• Hindi effective ang antihistamine (cetirizine) dahil hindi ito allergic reaction 1
• Ang dyshidrosis ay vesicular, recurrent disease ng palms at soles related to eczema, na may "ferocious pruritus" 4

Iba Pang Posibilidad (Mas Rare)

• Palmoplantar psoriasis - Pero usually may visible plaques with silvery scale 1, 5
• Post-vaccination reaction - Pero walang recent vaccination na nabanggit 6
• Palmoplantar pustulosis - Pero usually may pustules, hindi lang kati 7, 8

Recommended Management Algorithm

First-Line Treatment (Simulan Agad)

1. Clobetasol propionate 0.05% cream o ointment - Lagyan ang affected areas twice daily 1

   • Ito ang pinaka-potent topical steroid para sa palmoplantar conditions 1

2. Urea 10% cream - Lagyan three times daily, including after hand washing 1

   • May keratolytic at humectant effects 1

3. "Soak and Smear" technique 1:

   • Ibabad ang kamay sa plain water for 20 minutes
   • Lagyan ng moisturizer habang basa pa ang skin para mas tumatak 1

Kung Walang Improvement After 4 Weeks

• Mag-refer sa dermatologist para sa topical PUVA therapy (psoralen plus UVA) 2-3 sessions weekly 1
• Alternative: 308-nm excimer laser for targeted phototherapy 1

Severe o Refractory Cases

• Acitretin 25 mg daily - Pero kailangan ng dermatologist prescription at lipid panel monitoring 1, 5

Critical Pitfalls na Iwasan

• Huwag mag-assume na simple dermatitis lang - Kung bumalik ang lagnat with palmar rash, RMSF mortality increases dramatically with delayed treatment 1
• Huwag umasa sa antihistamine - Ang dyshidrotic eczema ay hindi allergic reaction kaya ineffective ang cetirizine 1, 4
• Huwag mag-scratch - Pwedeng mag-superinfection ang vesicles 4

Red Flags: Bumalik sa Doctor Kung

• Bumalik ang lagnat 2, 3
• May lumabas na pustules o blisters 7
• Lumalala ang symptoms despite treatment 1
• May systemic symptoms (headache, confusion, body weakness) 2

Expected Timeline

• Ang dyshidrotic vesicles usually dry up and disappear within 3 weeks 4
• Pero relapses are frequent, especially sa patients with atopy o sweat gland disorders 4
• Kaya importante ang maintenance therapy with moisturizers 1