Viral and Non-Viral Causes of Palmoplantar Rashes

Introduction to Palmoplantar Rashes

Certain enteroviruses (coxsackievirus and echovirus) can cause palmoplantar involvement, though most enteroviral infections spare palms, soles, face, and scalp 1, 2
The Centers for Disease Control and Prevention recommends considering Rocky Mountain Spotted Fever (RMSF) in patients with fever, headache, and rash, particularly if there is a history of tick exposure 1, 2

The Centers for Disease Control and Prevention notes that RMSF can present with a rash that progresses to maculopapular with central petechiae, spreading centripetally to involve palms and soles in approximately 50% of cases 1, 3
The American Academy of Pediatrics recommends immediate empiric treatment with doxycycline if RMSF is suspected, without waiting for laboratory confirmation 2
Human Monocytic Ehrlichiosis (HME) can cause a rash in approximately 30% of adults, with palmoplantar involvement being rare 1, 2, 3
Secondary Syphilis can cause a maculopapular rash that characteristically involves palms and soles 1, 4

The Centers for Disease Control and Prevention recommends assessing for life-threatening causes of palmoplantar rash, including RMSF and meningococcemia, and initiating empiric treatment if suspected 1, 2, 4
Obtaining a complete blood count with differential, comprehensive metabolic panel, and acute serology for R. rickettsii, E. chaffeensis, and A. phagocytophilum can help diagnose RMSF and other life-threatening causes 2, 3, 4

The American Academy of Pediatrics recommends doxycycline 100 mg twice daily as empiric treatment for RMSF, without waiting for laboratory confirmation 2
The Centers for Disease Control and Prevention notes that delaying treatment for RMSF can significantly increase the risk of mortality, with a mortality rate of 5-10% 2