When An Adult Patient Presents With Red Spots On The Feet

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When An Adult Patient Presents With Red Spots On The Feet
Key Questions To Consider
Answering The Key Diagnostic Questions
Dr. Dockery is a Fellow of the American College of Foot and Ankle Surgeons, and the American Society of Podiatric Dermatology. He is board certified in foot and ankle surgery. Dr. Dockery is the Chairman of the Board and Director of Scientific Affairs for
By G. “Dock” Dockery, DPM, FACFAS

Scabies. The lesions of a scabies infestation may involve the hands and feet. They are usually very pruritic in nature, especially at night. Scabies may bite and burrow into the skin of the fingers, toes, palms and soles, and typical burrows of the female mite may be found by careful examination. Due to the intense pruritus, patient scratching excoriates many of the lesions.

Insect bites and stings. These may involve both the feet or hands, and cause significant pruritus. Most bites are on the dorsum of the hand and foot rather than the palmoplantar surfaces. In most cases, the reactions from bites are much more erythematous and inflamed with fewer vesicles than one would find with dyshidrotic dermatitis.

Key Insights On Prevention And Treatment
Preventive measures include good hand washing in children and adults, especially after using the toilet and changing a diaper, and before preparing food and eating. Routine disinfection of common areas with wipes or solutions with germ-killing alcohol is beneficial.

One may use other disinfectants, such as a diluted solution of chlorine-containing bleach (10% concentration), for cleaning shared toys. Doing so prevents the spread of infection to siblings or children within the same home or child care center. Blisters should not be ruptured as this allows for rapid viral spreading. Patients with HFMD should limit their exposure to others and children should be kept out of daycare or school until their fever is resolved.

There is no specific treatment for HFMD but general treatment is supportive and symptomatic for relief of fever, aches or painful mouth ulcers. Patients are advised to get sufficient rest, drink plenty of fluids and take over-the-counter pain relievers, such as acetaminophen or ibuprofen, if needed. Prevention of dehydration in babies and young children is essential, and one should not use aspirin in children under age 13.


Suggested Reading

1. Bryld LE, Agner T, Menne T. Relation between vesicular eruptions on the hands and tinea pedis, atopic dermatitis and nickel allergy. Acta Derm Venereol. 2003;83:186-188.
2. Dockery GL. Viral Skin Infections, ch. 7, in: Cutaneous Disorders of the Lower Extremity. W.B. Saunders Co., Philadelphia, pp. 80-82, 1997.
3. Dockery GL, Schroeder S. How to Diagnose and Treat Insect Bites and Stings. Podiatry Today. 19(6):90-98, 2006.
4. Dockery GL, Bakotic B. What You Should Know About Lichen Planus. Podiatry Today, 20(6):52-60, 2007.
5. Frydenberg A, Starr M. Hand, foot and mouth disease. Aust Fam Physician 32(8):594-595, 2003.
6. Graham BS. Hand-Foot-and-Mouth Disease. eMedicine March 9, 2007. Available at: www.emedicine.com/derm/topic 175.htm
7. Nervi SJ, Schwartz RA, Kapila R, Johnson DH. Hand-Foot-and-Mouth Disease. eMedicine June 29, 2006. Available at: www.emedicine.com/med/topic944.htm.
8. Sperling J, Sayan OR, Carter WA. Would you miss this diagnosis? Emergency Med. 39(4):21-22, 2007.
9. Sutton-Hayes S, Weiss ME, Wilson NW, Ogershok PR. A recurrent presentation of hand, foot and mouth disease. Clin Pediatr, 45(4):373-376, 2006.

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