Differential Diagnosis for Sore Skin on Hands
The patient presents with sore skin on the hands, specifically on the bottom of the palm, fingers near the nails, and the middle part of the fingers, with cracked open sores. Given her medical history and current medications, the following differential diagnoses are considered:
- Single Most Likely Diagnosis
- Inverse Psoriasis: Given the patient's history of inverse psoriasis, it is likely that her current symptoms are a flare-up of this condition. Inverse psoriasis can cause smooth, red, and shiny lesions in the skin folds, including the palms of the hands and fingers.
- Other Likely Diagnoses
- Dyshidrotic Eczema: This condition is characterized by small, itchy blisters on the hands and feet, often accompanied by dry, cracked skin. The patient's symptoms, including cracked open sores, are consistent with dyshidrotic eczema.
- Irritant Contact Dermatitis: The patient's occupation or exposure to certain substances could be causing irritant contact dermatitis, leading to sore skin on the hands.
- Thyroid-Related Skin Changes: Hypothyroidism can cause skin changes, including dryness, cracking, and thickening of the skin, which may contribute to the patient's symptoms.
- Do Not Miss Diagnoses
- Squamous Cell Carcinoma: Although less likely, it is essential to consider the possibility of skin cancer, particularly in areas exposed to the sun or with a history of skin lesions.
- Infections (e.g., Staphylococcal or Herpes Simplex): Bacterial or viral infections can cause skin lesions and sores, and it is crucial to rule out these possibilities to provide appropriate treatment.
- Rare Diagnoses
- Pompholyx: A rare condition characterized by blisters on the palms and soles, often accompanied by itching and burning sensations.
- Keratoderma: A group of rare skin conditions that cause thickening of the skin on the palms and soles, which may lead to cracking and soreness.
Each of these diagnoses should be considered and evaluated through a combination of physical examination, medical history, and diagnostic tests to determine the underlying cause of the patient's symptoms.