Differential Diagnosis for Pediatric Rashes Involving Palms and Soles
Single Most Likely Diagnosis
- Hand, Foot, and Mouth Disease (HFMD): This is a common viral illness in children, characterized by a rash on the palms and soles, along with oral ulcers. The presence of fever and the typical distribution of the rash make HFMD a leading consideration.
Other Likely Diagnoses
- Kawasaki Disease: An acute febrile illness that can present with rash, including involvement of the palms and soles, along with other systemic symptoms like fever, conjunctivitis, and lymphadenopathy.
- Impetigo: A bacterial skin infection that can occasionally involve the palms and soles, presenting with honey-colored crusts and erythema.
- Scabies: A parasitic infection causing intense itching and a rash that can involve the palms and soles in infants and young children.
Do Not Miss Diagnoses
- Secondary Syphilis: Although less common, syphilis can cause a rash on the palms and soles. Given the potential for severe consequences if untreated, it's crucial to consider syphilis in the differential diagnosis.
- Meningococcemia: A life-threatening infection that can cause a rash, which may initially appear on the palms and soles. Prompt recognition and treatment are critical.
- Rocky Mountain Spotted Fever (RMSF): A tick-borne illness that can present with a rash on the palms and soles, along with fever and other systemic symptoms. Early diagnosis and treatment are essential to prevent serious complications.
Rare Diagnoses
- Pittsburgh Pox (Pittsburgh Pox Virus): A rare viral infection that can cause a rash, including on the palms and soles, though it's less commonly encountered.
- Enteroviral infections other than HFMD: Certain enteroviruses can cause rashes on the palms and soles, though these are less common than HFMD.
- Erythema multiforme: An immune-mediated condition that can cause target-like lesions on the skin, including the palms and soles, often in response to infections or medications.