Pine Nut, great ideas! Thanks! I am leaving to visit with the dermatologist soon. I don't have anything on my feet. However your #4 sounds exactly like what I have. I think that may be a combination with #2. Thank you all for helping out. What a great website with such friendly people willing to help out. I am truly grateful.
Painful Red Bumps just on palms of hands
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Quote:
Originally Posted by PineNut
To consider include:
1.Dyshidrosis or Dyshidrotic Eczema (Pompholyx)
2.Foreign body response to slivers of diatomaceous crystals from the sand
3.Irritant dermatitis or friction induced dermatitis from grabbing scuba tank or dive boat ladder
4.Contact allergic dermatitis of the palms or soles often result in a bumpy or clear pebbles under the skin
5.Friction induced urticaria, perhaps from the seafood you had the night before
If the lesions are found both on the hands and feet, then dyshidrosis, pustular psoriasis, and hand foot and mouth disease should be considered.
Regarding #5, what kind of seafood would one have for dinner that would cause "friction induced urticaria" of the hands and feet? Would have be some rough and resistant bivalves and crustaceans ; )
Regarding HFMD, the following describes (and contains photos of) of the condition --> Hand-foot-and-mouth disease - MayoClinic.com. According to this definition and symptom description, the OP would seem to be a monosymptomatic case. As such, I find this a reach as a reasonable r/o dx.
Finally, leaving aside the rarity of pustular psoriasis (NOS), I don't find this compelling. Neither the description of the lesions nor the history appear consistent with palmoplantar pustulosis.
Regards,
DocVikingo
Originally Posted by PineNut
To consider include:
1.Dyshidrosis or Dyshidrotic Eczema (Pompholyx)
2.Foreign body response to slivers of diatomaceous crystals from the sand
3.Irritant dermatitis or friction induced dermatitis from grabbing scuba tank or dive boat ladder
4.Contact allergic dermatitis of the palms or soles often result in a bumpy or clear pebbles under the skin
5.Friction induced urticaria, perhaps from the seafood you had the night before
If the lesions are found both on the hands and feet, then dyshidrosis, pustular psoriasis, and hand foot and mouth disease should be considered.
Regarding #5, what kind of seafood would one have for dinner that would cause "friction induced urticaria" of the hands and feet? Would have be some rough and resistant bivalves and crustaceans ; )
Regarding HFMD, the following describes (and contains photos of) of the condition --> Hand-foot-and-mouth disease - MayoClinic.com. According to this definition and symptom description, the OP would seem to be a monosymptomatic case. As such, I find this a reach as a reasonable r/o dx.
Finally, leaving aside the rarity of pustular psoriasis (NOS), I don't find this compelling. Neither the description of the lesions nor the history appear consistent with palmoplantar pustulosis.
Regards,
DocVikingo
A good differential diagnosis is absolutely necessary for the work up of any medical condition, DocVikingo. Things don't happen in real life like they do in the movies or the text book.
As TSM suggested, hand foot and mouth disease, I left it in the differential diagnosis. And I commend her for suggesting it.
Histamine induced urticarial reaction can occur from consumption of fish and seafood (http://www.urticaria.thunderworksinc.com/pages/lowhistamine.htm), and can make one more prone to dermatographism or "friction induced" urticaria (http://allergies.about.com/od/urticariahives/a/dermatographism.htm), as I chose to pick the words.
I have had arguments against my diagnosis by other doctors. But by being tunnel vision - you will miss the diagnosis of atypical viral illnesses and diseases modified by other factors.
Example - pityriasis rosae rarely present in a christmas tree fashion, herpes zoster does not always present with stabbing pain nor skin lesions, and herpes simplex one does not always present with labial lesions. By sticking to the book - you will miss unusual diagnosis.
A week ago, I saw a man for scalp itching over 6 months. Conservative treatment did not work. An HIV was positive. He responded tremendously to Diflucan. You can argue that it is not pityrosporum folliculitis - but the fact is, he responded.
All good differential diagnosis require a good list. Then the peanut gallery can start throwing.
As TSM suggested, hand foot and mouth disease, I left it in the differential diagnosis. And I commend her for suggesting it.
Histamine induced urticarial reaction can occur from consumption of fish and seafood (http://www.urticaria.thunderworksinc.com/pages/lowhistamine.htm), and can make one more prone to dermatographism or "friction induced" urticaria (http://allergies.about.com/od/urticariahives/a/dermatographism.htm), as I chose to pick the words.
I have had arguments against my diagnosis by other doctors. But by being tunnel vision - you will miss the diagnosis of atypical viral illnesses and diseases modified by other factors.
Example - pityriasis rosae rarely present in a christmas tree fashion, herpes zoster does not always present with stabbing pain nor skin lesions, and herpes simplex one does not always present with labial lesions. By sticking to the book - you will miss unusual diagnosis.
A week ago, I saw a man for scalp itching over 6 months. Conservative treatment did not work. An HIV was positive. He responded tremendously to Diflucan. You can argue that it is not pityrosporum folliculitis - but the fact is, he responded.
All good differential diagnosis require a good list. Then the peanut gallery can start throwing.
Other important differential to consider:
6. Perpetuation of an irritant dermatitis by a contact allergen (example topical neosporin, topical bacitracin, or topical diphenhydramine).
7. An unusual case of herpetic whitlow (where have you stuck your hand recently?? ) Just kidding, I was going to say up someone's .....
6. Perpetuation of an irritant dermatitis by a contact allergen (example topical neosporin, topical bacitracin, or topical diphenhydramine).
7. An unusual case of herpetic whitlow (where have you stuck your hand recently?? ) Just kidding, I was going to say up someone's .....
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Ah, yes, "Pine Nut," now that you've made a few "adjustments" to your responses it's all quite clear.
Well.. I am back from the doc! As I first suspected, she really didn't know exactly what it was except for the fact my hands had areas that were inflamed deep under the skin. She guessed it was some kind of foreign substance that my hands did not like and was not worried about it. She prescribed a topical steroid and sent me on my way. My hands are definitely getting better, so it was nothing serious and definitely not hand, foot, and mouth disease. 
Thanks again, guys!
Thanks again, guys!
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Hi BenDiver,
Good news.
Appreciate the follow up -- it's how we learn. Your doctor's response certainly backs up what TSandM said regarding the difficulty in diagnosing many skin conditions.
And of course you don't have HFMD. I repost this link from my immediately prior post in this thread: Hand-foot-and-mouth disease - MayoClinic.com
Regards,
DocVikingo
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