55-Year-Old With Hand Rash

Diagnosis

The correct diagnosis in this case is palmoplantar pustulosis, a chronic eruption of the palms and soles, composed of sterile vesicles and pustules, often accompanied by painful fissuring. It is mostly seen in middle-aged women. Palmoplantar pustulosis may occur alongside or follow a systemic infection, including group A streptococcal infection. It may also be triggered by tumor necrosis factor-alpha inhibitor medication or metal allergy. 

What To Look For

• Systemic symptoms are usually absent
• Besides the pustules/vesicles/fissures, there may be pain, pruritus, or a burning sensation
• Symptoms are limited to the palms and soles

Pearls For Urgent Care Management

• Palmoplantar pustulosis may resolve spontaneously; however, periods of exacerbation and remission may occur
• First-line treatment includes the use of a medium potency topical corticosteroid for 4 weeks
• Follow-up with dermatology should be recommended

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