Diagnosis and Treatment of Descamative Lesions on Palms, Soles, and Face

Diagnostic Considerations

The American Academy of Pediatrics suggests that fever is typically the first symptom of Hand, Foot, and Mouth Disease (HFMD), generally of low grade but can exceed 39°C (102.2°F), accompanied by malaise, sore throat, and irritability in young children 1
The Centers for Disease Control and Prevention (CDC) notes that the exanthem begins as small pink macules that evolve into vesicular lesions, with a highly characteristic distribution on palms and soles 1
The CDC also states that the vesicles subsequently rupture and cause desquamation, especially on palms and soles 1
The World Health Organization (WHO) recommends considering potentially life-threatening infections, such as Rocky Mountain spotted fever, if the patient appears severely ill with high fever 2

The Infectious Diseases Society of America (IDSA) suggests that Rocky Mountain spotted fever presents with a maculopapular rash that spreads to palms and soles 2-4 days after the onset of fever, with a mortality rate of 5-10% if left untreated 2
The IDSA also notes that Ehrlichiosis presents with fever, headache, and rash involving palms/soles in 30% of adults and 60% of children, with a mortality rate of 3% 2

The American Academy of Pediatrics recommends supportive management, including fever control and adequate hydration, for HFMD 1
The CDC states that the disease is self-limiting, with typical resolution in 7-10 days 1
The WHO suggests that doxycycline should be administered immediately if Rocky Mountain spotted fever is suspected, without waiting for confirmation 2
The British Association of Dermatologists recommends an expectant approach for warts in immunocompetent patients, as spontaneous clearance occurs in half of children within 1 year 3

The American Academy of Pediatrics advises against confusing HFMD with Kawasaki disease: HFMD has discrete vesicles, not diffuse erythema 1
The CDC warns against delaying treatment for suspected Rocky Mountain spotted fever, as this significantly increases mortality 2
The WHO cautions against assuming that all palmoplantar eruptions are benign: consider infectious causes if there is high fever and toxic appearance 2
The British Association of Dermatologists recommends against aggressive treatment of warts in immunocompetent children: spontaneous clearance is common 3

The Centers for Disease Control and Prevention recommends administering doxycycline immediately without waiting for confirmation if Rocky Mountain spotted fever is suspected, as mortality reaches 5-10% if untreated 4
The Centers for Disease Control and Prevention suggests that meningococcal disease cannot be reliably distinguished from tick-borne rickettsial disease on clinical grounds alone, and some experts recommend intramuscular ceftriaxone pending blood cultures 4
For a 1-year-old child with hand and foot rashes, the American Academy of Pediatrics recommends a dose of ibuprofen of 10 mg/kg/dose every 6-8 hours as needed, with a maximum of 40 mg/kg/day 4