Causes of Itchy Palms and Soles

Palmoplantar pruritus or itchy palms and soles have multiple causes like atopy, dry skin, exposure to allergens and certain systemic and skin diseases.

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

Many of the causes for itchy palms and soles are from outside sources:

• 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.

Though the primary source for the itchy hands and feet is external in these cases, an internal tendency for the skin to be irritated has to be there for the itching and other changes to manifest in such cases.

Endogenous Causes for Itchy Palms and Soles

The internal causes for the itchy palms and soles are more difficult to discern. These include systemic and psychological disturbances at times:

• 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.

The above discussion brings out a salient point: look beyond the skin if the cause of the itchy palms and soles are not readily apparent.

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

• How to Find the Cause of Itchy Palms and Soles
• Treatment of Itchy Palms and Soles

Reference

• Pruritus & Contact Dermatitis, in Rook’s Textbook of Dermatology, 7th Edition, 2004
• Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, 2005