Several other generalized skin disorders have classic clinical findings on the palms and soles. These disorders are discussed in more detail in Chap 241; however, they are mentioned briefly here so as to be reminded of these disorders when a patient presents with a complaint in one of these body regions.
Erythema multiforme has characteristic findings on the palms and soles. These lesions are erythematous macules with a violaceous, dusky or bullous center. They are commonly referred to as target or iris lesions. Discovering such lesions should incite a search for similar lesions on the rest of the body, hemorrhagic erosions on the mucosal surfaces, and conjunctival hemorrhage in the eyes.
Secondary syphilis also has characteristic palm and sole lesions. These lesions are red-brown to brown macules on the palms and soles. Although patients with darker pigmented skin may have several hyperpigmented macules as a normal finding, recent onset or failure of the patient to recall such lesions should increase the clinician's suspicion of secondary syphilis. These lesions are often asymptomatic and may be the only indication of secondary syphilis. A high index of suspicion is necessary, and appropriate further clinical examination and serology should be carried out.
Rocky Mountain spotted fever may also present initially with palm or sole lesions. These appear as blanching erythematous macules that later become nonblanching petechial lesions. These lesions start distally and spread proximally.
Kawasaki disease, scarlet fever, and toxic shock syndrome may all have palmar erythema as a prominent feature. The palms and soles will desquamate as these diseases progress.
Furthermore, when considering pruritic eruptions of the extremities, one must always think about scabies. The hands, feet, and elbows along with the groin are the most common areas of involvement. Diagnostic burrows will most likely be found in the hyperkeratotic skin of the palms and soles particularly along the web spaces and the wrist. When the scabetic mite burden becomes quite high, Norwegian scabies results. Thick hyperkeratosis resembling dermatitis results [ Fig 239-9 (Pjate
24)]. See Chap 242 for further discussion.
FIG. 239-9 (PJateM). Norwegian scabies. The thick scale, erythema, and exudate resemble a foot dermatitis. This disorder should not be forgotten when presented with a patient with extremely pruritic scaly eruption. Norwegian scabies is more common in immunocompromised and debilitated patients.
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Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.