How to differentiate RASH on Hands & feet (palms & soles) due to infection

1. Bacterial Infections:

a) Scarlet fever: caused by Erythrodermic extoxin of streptococcus pyogenes giving Sand paper rash, STRAWBERRY TONGUE.

b) Staphylococcal  scalding skin syndrome: caused by Exfoliating toxin giving SKIN PEEL-OFF on touch -> Nikolsky sign

c) Toxic Shock Syndrome (staphy. aureus)- caused by Collagenase toxins giving RED rash on skin and collagen (fascietis), including bones and joints. (skin, fascia, bones, joints).

2. Viral Infections:

a) Hand, foot & mouth disease – caused by Coxsackie-A virus, Mouth or oral Ulcers is differentiating factor.

b)some times Varicella (chicken pox) and Rubeola mimic the rash on hands on feet  depending upon situation of patient. Regional epidemic for varicella and KOPLICK’S SPOT for rubeola are differentials.

c) Human Herpes Virus (HHV 1-7)  various erythematous rash on body, extremities differentiating factor.

3. Kawasaki Disease: autoimmune disease where medium size vessels are inflamed. Lymphnodes disease, conjunctivitis, stomatitis & strawberry tongue, fever not responding to paracetamol & antibiotics. only IVIG & aspirin relieves.

4. Allergic reaction to medications (………. ) & Bites or stings of various bugs and flies.

PLEASE FEEL FREE TO ADD ANY OTHER DIFFERENTIALS IF YOU KNOW. Thank You in advance.