Palms and Soles

“The Thinker’s Rash…”

MAKES A MRC “Makes a Mark”

Measles Arthritis Kawasaki Endocarditis Syphilis

Allergy/Atopy

Meningococcemia Rickettsia Coxsackie

Measles

Koplik spots appear in the mouth before the macular rash that starts at the hairline, and progresses to the extremities.

Arthritis

Reactive arthritis (Reiter’s syndrome) — genitourinary infection, but may also occur after gastrointestinal illness; rash on palms and soles is called keratoderma blenorrhagicum

Kawasaki

The rash of Kawasaki Disease is notoriously variable. Look for the syndrome of conjunctivitis, rash (any), adenopathy, strawberry tongue, and/or desquamation. A Kawasaki-like syndrome is also seen with MIS-C. The rash on the palms and soles of Kawasaki Disease can be mimicked by other conditions, such as measles, Epstein-Barr virus, echovirus, among others.

Endocarditis

The Modified Duke Criteria apply to both adults and children. 3 minor criteria are enough to qualify for “Possible Infectious Endocarditis”.

Syphilis

Secondary syphilis may present on the palms and soles. Remember, syphilis is the “great imitator”; the rash may be variable, but will often match the clinical presentation as a whole (i.e. history and physical examination).

Allergy/Atopy

Especially dyshidrotic eczema

Meningococcus

The rash and presentation are dynamic.

Rickettsia

Rickettsia Spotted Fevers can be found worldwide.

Coxsackie

Aren’t you glad you saved this for last?

Selected references

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Dixon G, Christov G. Infective endocarditis in children: an update. Curr Opin Infect Dis. 2017 Jun;30(3):257-267. doi: 10.1097/QCO.0000000000000370. PMID: 28319472.

Elsner P, Agner T. Hand eczema: treatment. J Eur Acad Dermatol Venereol. 2020 Jan;34 Suppl 1:13-21. doi: 10.1111/jdv.16062. PMID: 31860736.

Jubber A, Moorthy A. Reactive arthritis: a clinical review. J R Coll Physicians Edinb. 2021 Sep;51(3):288-297. doi: 10.4997/JRCPE.2021.319. PMID: 34528623.

Keuning MW, Kamp GA, Schonenberg-Meinema D, Dorigo-Zetsma JW, van Zuiden JM, Pajkrt D. Congenital syphilis, the great imitator-case report and review. Lancet Infect Dis. 2020 Jul;20(7):e173-e179. doi: 10.1016/S1473-3099(20)30268-1. Epub 2020 Jun 2. PMID: 32502432.

Kimmis BD, Downing C, Tyring S. Hand-foot-and-mouth disease caused by coxsackievirus A6 on the rise. Cutis. 2018 Nov;102(5):353-356. PMID: 30566537.

Moss WJ. Measles. Lancet. 2017 Dec 2;390(10111):2490-2502. doi: 10.1016/S0140-6736(17)31463-0. Epub 2017 Jun 30. PMID: 28673424.

Muzumdar S, Rothe MJ, Grant-Kels JM. The rash with maculopapules and fever in children. Clin Dermatol. 2019 Mar-Apr;37(2):119-128. doi: 10.1016/j.clindermatol.2018.12.005. Epub 2018 Dec 5. PMID: 30981292.

Saguil A, Kane SF, Lauters R, Mercado MG. Hand-Foot-and-Mouth Disease: Rapid Evidence Review. Am Fam Physician. 2019 Oct 1;100(7):408-414. PMID: 31573162.

Satyaputra F, Hendry S, Braddick M, Sivabalan P, Norton R. The Laboratory Diagnosis of Syphilis. J Clin Microbiol. 2021 Sep 20;59(10):e0010021. doi: 10.1128/JCM.00100-21. Epub 2021 May 12. PMID: 33980644; PMCID: PMC8451404.

Tugelbayeva А, Ivanova R, Goremykina М, Rymbayeva Т, Toktabayeva B. REACTIVE ARTHRITIS IN CHILDREN (REVIEW). Georgian Med News. 2021 Feb;(311):130-135. PMID: 33814406.