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Allergic contact dermatitis

An intensely pruritic, vesicular rash on the palms in a pattern that suggests contact with an allergen, such as rubber in gloves or nickel in tools.

Disseminated gonococcal infection

A systemic bacterial infection with fever and arthritis, with a characteristic rash of hemorrhagic pustules on an erythematous base on the distal extremities, including palms.

Dyshidrotic eczema

A specific type of hand eczema characterized by an eruption of small, deep-seated, intensely itchy, 'tapioca-like' vesicles on the palms and sides of fingers.

Erythema multiforme

An acute hypersensitivity reaction causing characteristic 'target' or iris lesions, which have a strong predilection for the palms and soles.

Graft versus host disease

The acute cutaneous form commonly presents with a morbilliform eruption that prominently involves the palms and soles.

Hand foot and mouth disease

A common viral illness in children causing oral ulcers and a rash of oval-shaped vesicles on the palms and soles.

Janeway lesions

A sign of infective endocarditis, presenting as non-tender, erythematous or hemorrhagic macules and papules on the palms and soles.

Kawasaki disease

A childhood vasculitis causing fever and characteristic changes of the extremities, including erythema and swelling of the palms, followed by desquamation.

Kawasaki's disease

A childhood vasculitis causing fever and characteristic changes of the extremities, including erythema and swelling of the palms, followed by desquamation.

Measles

The morbilliform rash of measles can sometimes involve the palms and soles as it becomes confluent.

Perniosis

Also known as chilblains, this presents as painful, itchy, red to purple inflammatory papules and nodules on the hands after exposure to cold.

Rickettsial disease

Rocky Mountain Spotted Fever classically presents with a petechial rash that begins on the wrists and ankles and spreads centrally, prominently involving the palms and soles.

Secondary syphilis

The 'great imitator,' which classically causes a non-pruritic, symmetric, maculopapular or papulosquamous rash involving the palms and soles.

Stevens-Johnson syndrome

A severe drug reaction where atypical target lesions and bullae have a predilection for the palms and soles.

Tinea

A fungal infection of the hand (tinea manuum), often presenting as unilateral, diffuse, fine scaling and hyperkeratosis in the palmar creases.

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