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Hand and foot dermatitis is not a single disease. Rather, it is a categorization of dermatitis that affects the hands and feet selectively due to one of several causes.

Patients often present with isolated dermatitis of the hands or feet. Causes include contact dermatitis, fungal infection, psoriasis, and scabies; some cases are idiopathic. Diagnosis can sometimes be inferred from location and appearance of the skin lesions (see Table 3: Dermatitis: Differential Diagnosis of Hand Dermatitis). Treatment of all forms of hand and feet dermatitis should be directed at the underlying cause when possible. Topical corticosteroids or antifungals may be tried empirically. Patients should also avoid prolonged contact with water.

Table 3
Differential Diagnosis of Hand Dermatitis Location Erythema and Scaling Pustules Vesicles Palm Fingertip eczema Dyshidrotic dermatitis Allergic contact dermatitis   Hyperkeratotic eczema Infection (bacterial) Dyshidrotic dermatitis   Keratolysis exfoliativa Psoriasis     Psoriasis       Tinea     Dorsum Atopic dermatitis Infection (bacterial) Id reaction   Irritant contact dermatitis Psoriasis Scabies (web spaces)   Lichen simplex chronicus Scabies (web spaces)     Nummular eczema Tinea     Psoriasis       Tinea

Dyshidrotic dermatitis is characterized by pruritic vesicles or bullae on the palms, sides of the fingers, or soles. Scaling, redness, and oozing often follow vesiculation. Pompholyx is a severe form with bullae. The cause is unknown, but fungal infection, contact dermatitis, and id reactions to tinea pedis can cause a similar clinical appearance and should be ruled out. Treatment includes topical corticosteroids, tacrolimus Some Trade Names
PROGRAF
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or pimecrolimus Some Trade Names
ELIDEL
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, oral antibiotics, and ultraviolet light.

Keratolysis exfoliativa is painless patchy peeling of the palms and/or soles. The cause is unknown; treatment is unnecessary as the condition is self-resolving.

Hyperkeratotic eczema is thick yellow-brown plaques on the palms and sometimes soles. The cause is unknown. Treatment is with topical corticosteroids and keratolytics, ultraviolet A radiation with oral psoralen (PUVA), and retinoids.

Id reaction is appearance of vesicles usually on the sides of the fingers in response to active dermatitis elsewhere. The cause may be an allergic reaction.

“Housewives' eczema” affects people whose hands are frequently immersed in water. It is worsened by washing dishes, clothes, and babies because repeated exposure to even mild detergents and water or prolonged sweating under rubber gloves may irritate dermatitic skin or cause an irritant contact dermatitis.

Last full review/revision November 2005

Content last modified November 2005