Dermatologists and other health care practitioners are often visited by a patient with a

hand rash-sometimes accompanied by a foot rash also.

                                And,specialists like dermatologists often immmediately think of eczema,psoriasis,contact

dermatitis and, perhaps,even  a fungal infection.

                              As for myself,,in addition to taking a histoery of the rash  which includes how long he or she

has been aware of it,I also list any treatments already tried and I always ask the patient what he or she thinks

may have caused it.

                             In addition,I would immediately look at the patient's fingernails and elbows,looking for signs

of psoriasis which can be manifested by a red scaley plaque like surface on the elbows and ragged fingernails.

And,often I can make the diagnosis by the simple history and physical exam described above,especially if the

feet are also involved.

                           Also, a simple test for fungus not only includes taking a skin scraping for examination under

the microscope and /or a culture to try to grow it. In addition,a fungal rash is more likely to involve 2 hands

and 1 foot or 2 feet and 1 hand-thus,adding up to 3 rather than 2 hands and/or  2 feet .

                          However, the main thrust of this narrative is to impress upon the reader that there are many

more serious causes of hand and foot rashes than the above.

                         To begin with, Woringer Kolopp disease which is a cutaneous form of an internal cancer

called lymphoma is manifested by psoriasis like thickened plaques on the hands and also the feet. It is

a type of mycoses fungoides lymphoma which can be treated by surgical excision and radiation therapy

and could easily be mistaken clinically for psoriasis.

                        Another serious disease that can appear as a rash on the hands and feet is palmoplantar

syphilis which  could be misdiagnosed as palmoplantar psoriasis. In fact, secondary syphilis has often been

called one of the great  masqueraders in dermatology since it can mimic many types of skin didease and

is often missed when it can frequently diagnosed with a simple blood test.

                       Basex syndrome is a paraneoplastic(a set of signs and symptoms that is a consequence of

cancer in the body but is not due to the local presence of cancer cells)syndrome characterized by thickened

skin on the hands or feet(ie,acral areas) as well as on the ears and nose . It is associated with malignancies

of the upper aero digestive tract such as cancer of the esophagus.

                     And, I would not want to leave this topic by not discussing the entity known as "mechanic's

hands." Mechanics hands refers to a non-itching, thickened skin eruption accompanied by scaling,fissuring and

hyperpigmentation giving one the  appearance of the calloused hands of a manual laborer.

                   In my opinion,mechanics hands could be easily misdiagnosed as hand eczema. However,

over the years mechanics hands have become recognized as a clinical marker  for pulmonary disease

as well as occurring in a condition called Dermatomyositis . People with the latter have not only skin

rashes but a 20 % incidence of internal cancer.

                  Dermatomyositis is also characterized by muscle weakness,various other skin findings as

well as a marked sensitivity to the sun.,

                 In summary, I would urge patients with  dry thickened  skin on their hands(and feet) that has

not responded to topical and (sometimes)internal steroids  or  antifungals  to see their healthcare

provder  for a detailed history and physical exam of the entire body looking for telltale signs of internal

malignancy.

                    Coming soon.