Stéphane, 40 years old, Foot and hand lesions and desquamation in oncology

Written with the participation of FDVF (Future Dermatologists and Venereologists of France) interns.

Quiz

18 respondents

Question of 1

What is your diagnosis? (only one correct response)

Palmoplantar psoriasis

Wrong answer!

It was hand-foot syndrome.

Let’s rule out differential diagnoses:

Psoriasis:

The diagnosis of psoriasis can in theory be ruled out given the absence of scales and psoriasiform lesions on the rest of the tegument and the lack of a personal history of psoriasis.

Eczema:

The diagnosis of eczema can in theory be ruled out due to the absence of pruritus and the lack of a dermatological history.

Mycosis:

Mycosis can in theory be ruled out given the immediate involvement of both hands and both feet with a sensation of pain.

Eczema

Wrong answer!

It was hand-foot syndrome.

Let’s rule out differential diagnoses:

Psoriasis:

The diagnosis of psoriasis can in theory be ruled out given the absence of scales and psoriasiform lesions on the rest of the tegument and the lack of a personal history of psoriasis.

Eczema:

The diagnosis of eczema can in theory be ruled out due to the absence of pruritus and the lack of a dermatological history.

Mycosis:

Mycosis can in theory be ruled out given the immediate involvement of both hands and both feet with a sensation of pain.

Hand-foot syndrome

True

Hand-foot syndrome

It is indeed hand-foot syndrome.

Let’s rule out differential diagnoses:

Psoriasis:

The diagnosis of psoriasis can in theory be ruled out given the absence of scales and psoriasiform lesions on the rest of the tegument and the lack of a personal history of psoriasis.

Eczema:

The diagnosis of eczema can in theory be ruled out due to the absence of pruritus and the lack of a dermatological history.

Mycosis:

Mycosis can in theory be ruled out given the immediate involvement of both hands and both feet with a sensation of pain.

Mycosis

Wrong answer!

It was hand-foot syndrome.

Let’s rule out differential diagnoses:

Psoriasis:

The diagnosis of psoriasis can in theory be ruled out given the absence of scales and psoriasiform lesions on the rest of the tegument and the lack of a personal history of psoriasis.

Eczema:

The diagnosis of eczema can in theory be ruled out due to the absence of pruritus and the lack of a dermatological history.

Mycosis:

Mycosis can in theory be ruled out given the immediate involvement of both hands and both feet with a sensation of pain.

Hand-foot syndrome should be suspected when faced with hand and/or foot lesions in patients undergoing chemotherapies known to induce this syndrome.
Hand-foot syndrome is graded based on the severity of the damage:

- Grade 1: Mild swelling, redness and tingling but they do not interfere with everyday life.

- Grade 2: Redness, swelling, bullae, and sensations of pain and burning but the patient can still walk or hold objects.

- Grade 3: The patient suffers a lot. The skin is very dry; it thickens and peels. They can no longer carry out their daily activities.

N.B: There can also be grading based on the impact on (basic/instrumental) daily activities