What causes tender, red, itchy spots on my hands and feet?

Hi,

I am glad you chose icliniq for your medical-related queries.

I understand your concern and will try to help you with it.

I saw your pictures (attachment removed to protect patient identity). There are multiple erythematous (red) plaques and papules (bumps) on palms, soles, and wrists. Few lesions do look like target lesions. With these features, I can list a few possibilities as follows:

1. Erythema multiforme: Could be drug-induced or because of underlying infections, common viral infections.
2. Hand, foot, and mouth disease: Viral rash (common in children, presents with fever, painful papules, blisters over palms, soles and mouth).
3. Dyshidrotic eczema: Due to abnormal sweating.
4. Drug rash: any oral medicine, commonly NSAIDs, painkillers or cough medicine.

May I know your age? Is there any similar rash inside the mouth? Did you have a fever before this rash or in the past one month? Have you used any topical cream? Is it the first episode? Did you take any painkillers, Ibuprofen, Diclofenac in the recent past? Do you have any history of eczema?

Thank you for consulting me.

You can always reach me at icliniq.com.

Thank you.

Hi,

Welcome back to icliniq.com.

I read and understand your concern.

Since you have or had no fever, chances of hand, foot and mouth disease is less likely. Drug rash will be very itchy. A history of fever blisters means herpes simplex 1 infection. Hence, it is pointing more towards erythema multiforme. Considering all these data and pictures, I am narrowing down to erythema multiforme (EMF). This is my clinical diagnosis. Sometimes it is difficult to confirm the diagnosis without the help of skin biopsy.

EMF is an immune response of the body to various triggers like viral infections (most commonly herpes virus), bacterial, fungal infections, certain medications like Bactrim, Ibuprofen, Poison ivy. EMF is usually self-limiting, resolves on its own, but sometimes can be persistent. In such case skin biopsy is necessary.

Treatment for this condition is usually symptomatic (treating the symptoms):

1. Calamine lotion with Aloe combination cream or lotion. In my country, we have a product by name Dermadew caloe lotion, it is the combination of Calamine and Aloe. It helps to soothen the skin.
2. Triamcinolone acetonide 0.1 % cream or Mometasone 0.1 % cream (topical corticosteroids). It is helpful in itchy and painful EMF. It can be used upto two weeks as a spot treatment. It should not be used for more than two weeks.
3. Oral corticosteroids, only in severe cases, with involvement of mouth and eyes.

Looking forward to your response in order to help you.

Thank you.