Differential Diagnosis for Bilateral Hand Pustules
Single Most Likely Diagnosis
- Acute generalized pustular psoriasis: This condition is characterized by the sudden onset of widespread pustules, often on the hands and feet, and can be triggered by various factors including infections, medications, and stress. The rapid onset overnight fits with the typical presentation of this condition.
Other Likely Diagnoses
- Pompholyx (dyshidrotic eczema): A type of eczema that presents with small, itchy blisters or pustules on the hands and feet, often related to stress, allergies, or irritants.
- Contact dermatitis: An allergic or irritant reaction to substances that come into contact with the skin, which can cause pustules among other symptoms.
- Bacterial infections (e.g., folliculitis, impetigo): Infections of the skin caused by bacteria, which can lead to pustular lesions.
Do Not Miss Diagnoses
- Septicemia or bacteremia with skin manifestations: Although less common, certain bacterial infections can cause pustular skin lesions as part of a systemic infection, which would be critical to identify and treat promptly.
- Meningococcemia: A severe infection caused by Neisseria meningitidis, which can present with a petechial or pustular rash, among other symptoms, and requires immediate medical attention.
Rare Diagnoses
- Sweet syndrome (acute febrile neutrophilic dermatosis): A rare condition characterized by fever, neutrophilia, and tender, erythematous skin lesions, which can sometimes appear pustular.
- Subcorneal pustular dermatosis: A rare skin condition that presents with pustules, typically on the trunk, but can occasionally involve the hands.
- Dermatologic manifestations of systemic diseases (e.g., Behçet's disease, rheumatoid arthritis): Certain systemic diseases can have skin manifestations, including pustules, though these would be part of a broader clinical picture.