Severely itchy palms and soles can present with or without any evident skin rashes. Most of the causes of itchy palms and soles are similar to that of hand eczema and can be broadly divided into exogenous and endogenous.
Exogenous Causes for Itchy Palms and Soles
- Contact Dermatitis. Hand eczema and foot dermatitis caused by irritants like cosmetics, soap and detergents and allergens like nickel and rubber can cause severe itchy palms and soles. Housewives’ getting severe itching of hands following handling of items like garlic and some vegetables is a common occurrence. Sudden itching of the palms and soles can occur following ingested food (seafood) or medications like penicillins, sulfa drugs etc. Solvents, paints and fiber glass exposure are also important causes for itchy palms and soles triggered by contact dermatitis.
- Infections. A secondary infection of a wound on the hands and feet can cause dermatitis if not treated promptly. The bacterial proteins act as antigens to produce inflammatory skin changes resulting in itchy hands and feet.
- Secondary dissemination. A secondary ide eruption or pompholyx caused by a fungal or bacterial infection in a remote site can cause tense, itchy or painful eruptions on the palms and soles.
Endogenous Causes for Itchy Palms and Soles
- Systemic causes for itchy palms and soles. Chronic kidney failure, liver diseases, endocrine disturbances like hyper or hypothyroidism, blood disorders including polycythemia vera, Hodgkin’s lymphoma, leukemias, multiple myeloma and cutaneous mastocystosis cause generalized itching; which can, at times, start as itching of the palms and soles. Itching of the palms and soles and elsewhere on the body may be a presenting symptom of HIV infection and Crohn’s disease. Atopic dermatitis, senile pruritus and aquagenic pruritus can present with itchy palms and soles, in addition to generalized itching all over the body.
- Idiopathic causes for itchy palms and soles. Many a time, itching of the palms and soles appear without any apparent causes. These are called idiopathic itchy palms and soles.
- Psychogenic causes for itchy palms and soles. Stress and anxiety can induce, aggravate and maintain persistent itchy palms and soles, in the absence of any skin rashes.
- Vitamin Deficiency. Vitamin deficiency, especially that of Vitamin B12, B1 and B6 can cause burning and itching sensations of the hands and feet.
- Dyshidrotic. Palmoplantar hyperhidrosis, the increased sweating of the palms and soles, can cause eczematous itchy dermatitis on the palms and soles.
Other Skin Conditions Causing Itchy Palms and Soles
Other major skin conditions that cause itchy palms and soles are:
- Palmoplantar psoriasis: Thick hyperkeratotic scaly plaques with painful fissuring and varying grades of itching can occur in psoriasis affecting the palms and soles.
- Ring worm of the hands and feet: Itchy rounded scaly skin patches involving both the palms and soles and also the back of the hands and feet occur in ring worm infestation of the hands and feet. Sometimes the scales are delicate and at other times thick and hyperkeratotic.
- Scabies. Itching of the hands, especially on the finger webs, may be the presenting symptom of scabies. The typical nocturnal itching may be present even before any tell tale bumps and burrows of the mites appear on the skin.
- Lichen planus, can cause severe itchy palms and soles, along with violaceous or pigmented skin rashes.
- Candidal intertrigo: Commonly seen in housewives and hair dressers, candidal infection of the finger web spaces and toe web spaces in house cleaners and agricultural workers can cause itchy or burning palms and soles.
Itchy Palms and Soles without Skin Changes
Sometimes both the doctor and patient are perplexed when itchy palms and soles present without any noticeable skin changes. The skin of palms and soles being thick, most of the time itching precedes appearance of skin changes by hours to days in contact dermatitis, pompholyx , scabies etc. In psychogenic itchy palms and soles, the skin changes may never appear. In systemic causes, including drug allergies, there may only be a mild redness of the skin, while the itching may be unbearable on the palms and soles. Generalized itching without skin rash may also be present in such cases.
Finding the exact cause of itchy palms and soles will help in planning effective management strategies for this intriguing skin problem.
Related Reading
Reference
- Pruritus & Contact Dermatitis, in Rook’s Textbook of Dermatology, 7th Edition, 2004
- Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, 2005
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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