Q. What can be done for tender and itchy red spots on hands?

Answered by
Dr. Ashwini V Swamy
and medically reviewed by iCliniq medical review team.
Published on Mar 20, 2018 and last reviewed on: May 30, 2019

Hello doctor,

I have red spots on my hands that started about 10 days ago. I also have a couple of spots on my foot. They are mildly tender and itchy. They have gotten worse but not more that 8 to 10. I have no medical history and do not take any medications daily. I had a cut on my finger from opening a metal box a few days before onset.

Dr. Ashwini V Swamy

Dermatology Venereology
#

Hi,

Welcome to icliniq.com.

I saw your pictures (attachment removed to protect patient identity). There are multiple erythematous (red) plaques and papules (bumps) on palms, sole, and wrist. Few lesions do look like target lesions. With these features, I can list a few possibilities as follows:

  1. Erythema multiforme: Could be drug-induced or because of underlying infections, common viral infections.
  2. Hand, foot, and mouth disease: Viral rash (common in children, presents with fever, painful papules, blisters over palms, soles and mouth).
  3. Dyshidrotic eczema: Due to abnormal sweating.
  4. Drug rash: any oral medicine, commonly NSAIDs, painkillers or cough medicine.

May I know your age? Is there any similar rash inside the mouth? Did you have a fever before this rash or in the past one month? Have you used any topical cream? Is it the first episode? Did you take any painkillers, Ibuprofen, Diclofenac in the recent past? Do you have any history of eczema?

For more information consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

Thank you doctor,

I do have a history of fever blisters since childhood but never genital lesions and have not had a fever blister in more than one year. I am 34 years old. No rash is there inside the mouth or recent fever or fever in the past month or even past several months that I know of. I tried using Hydrocortisone and antibiotic ointment but that seemed to make it worse but because I used them both I am not sure which one had aggrevated it. Yes, this is the first episode. Occasionally, I take Ibuprofen and there is no history of eczema.

Dr. Ashwini V Swamy

Dermatology Venereology
#

Hi,

Welcome back to icliniq.com.

Since you have or had no fever, chances of hand, foot and mouth disease is less likely. Drug rash will be very itchy. History of fever blisters means herpes simplex 1 infection. Hence, it is pointing more towards erythema multiforme. Considering all these data and pictures, I am narrowing down to erythema multiforme (EMF). This is my clinical diagnosis. Sometimes it is difficult to confirm the diagnosis without the help of skin biopsy.

EMF is an immune response of the body to various triggers like viral infections (most commonly herpes virus), bacterial, fungal infections, certain medications like Bactrim, Ibuprofen, Poison ivy. EMF is usually self-limiting, resolves on its own, but sometimes can be persistent. In such case skin biopsy is necessary.

Treatment for this condition is usually symptomatic (treating the symptoms):

  1. Calamine lotion with Aloe combination cream or lotion. In my country, we have a product by name Dermadew caloe lotion, it is the combination of Calamine and Aloe. It helps to soothen the skin.
  2. Triamcinolone acetonide 0.1 % cream or Mometasone 0.1 % cream (topical corticosteroids). It is helpful in itchy and painful EMF. It can be used upto two weeks as a spot treatment. It should not be used for more than two weeks.
  3. Oral corticosteroids, only in severe cases, with involvement of mouth and eyes.

For more information consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

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