25-Year-Old With Hand Rash

Differential Diagnosis

• Acquired palmoplantar keratoderma
• Toxic erythema of chemotherapy
• Drug-induced phototoxic reaction
• Erythromelalgia

Diagnosis

The correct diagnosis in this case is toxic erythema of chemotherapy (acral erythema, palmoplantar erythrodysesthesia, or hand-foot syndrome). It can occur following treatment with several systemic chemotherapeutic agents, although the pathogenic mechanisms are unknown.

What to Look For

• It is characterized by a painful erythematous rash, often with associated edema located on the palms, fingers, and soles, preceded by dysesthesia.
• Typically, reactions occur 24 hours to 3 weeks after chemotherapy begins, and more severe cases may occur with bolus chemotherapy than with low-dose continuous infusion.
• Pain may be severe and impact daily activities.

Pearls for Urgent Care Management

• Symptoms usually resolve 2-4 weeks after discontinuation of the causative agent
• Symptoms may resolve with dose reduction of the causative agent
• High potency topical corticosteroids applied 2 times daily can help
• Supportive treatment includes wound care, emollients, and analgesic pain medications

Read More

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• Evaluating Febrile Patients with Rash

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