Boy With Rash on Hands and Feet

THE CASE: A 6-year-old boy has a rash on his hands and feet that erupted shortly after he started first grade. His parents are concerned that he may be allergic to something at school, such as chalk. He is otherwise healthy.

Answer and Discussion on Next Page

Atopic Dermatitis is the correct answer.

DISCUSSION: This child has atopic dermatitis. The hyperlinearity of the palms confirms the presence of atopy. The stress of starting school was sufficient to exacerbate his condition. The rash was controlled with a mild topical corticosteroid.

Contact dermatitis is a possibility, and patch testing warrants consideration. Psoriasis can be ruled out by the absence of nail pitting and lack of involvement of other areas of the body. Dermatophyte infection of the palms would be unusual in this age group; it can be ruled out with a potassium hydroxide evaluation.

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Case and images courtesy of David L. Kaplan, MD, University of Missouri Kansas City, University of Kansas.