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Palmoplantar hyperkeratotic lesions pose a diagnostic difficulty when differentiating clinically between palmoplantar psoriasis (PPP) and palmoplantar eczema (PPE). Dermoscopy can provide valuable clues in reaching the final diagnosis.
The differential diagnosis of palmoplantar psoriasis includes dyshidrotic eczema, contact dermatitis, pityriasis rubra pilaris, acquired palmoplantar keratoderma, and tinea pedis/manuum.
Dyshidrotic eczema (pompholyx) is an itchy, chronic, recurrent, often symmetric eruption on the palms of hands, fingers, and soles of the feet. It is characterised by small, deep-seated, 1–2 mm fluid-filled vesicles on these sites, which resolve after several weeks with scaling.
Both are skin conditions with similar symptoms, but there are ways to tell them apart. Eczema causes an intense itch. It can get so bad that you scratch enough to make your skin bleed....
Dyshidrotic eczema (DE) or acute palmoplantar eczema is a common cause of hand and foot dermatitis in adults. It is a recurrent vesicular eruption affecting the soles, palms, or both. It is very pruriginous and generally appears suddenly.
A differential diagnosis of dyshidrotic eczema versus palmoplantar psoriasis versus allergic/irritant contact dermatitis of the palms and soles was established, though no triggers were identified. The patient deferred biopsy of the palms or soles.
This topic will discuss the pathogenesis, clinical presentation, diagnosis, and management of dyshidrotic eczema. Other forms of eczema involving the hands, including irritant and allergic contact dermatitis and atopic dermatitis, are discussed separately.
Abstract: Palmoplantar pustulosis (PPP) is a rare, chronic, recurrent inflammatory disease that affects the palms and/or the soles with sterile, erupting pustules, which are debilitating and usually resistant to treatment.
Palmoplantar pustulosis • Disease of adults, usually in middle age • Marked preponderance in women • May be a positive family history of psoriasis, though now thought to be a distinct entity from psoriasis • Presents with well-defined plaques on thenar/hypothenar eminence/palm, and on instep or medial or lateral border of foot ...
“Dyshidrotic eczema can mimic contact dermatitis and even palmoplantar pustulosis, a type of psoriasis appearing on the hands and feet,” said Siegfried. “The only way to tell which is which is with a biopsy. Without a definitive diagnosis, patients could receive suboptimal treatment.”