Clinical patterns of hand and foot dermatitis: emphasis on rubber and chromate allergens

The anatomic distribution of dermatitis affecting the hands and feet can provide clues to the likelihood that a contact allergen is provoking the dermatitis. Dermatitis presenting on the hands or feet, but not both, is more likely because of allergic contact dermatitis, whereas dermatitis affecting both the hands and feet is more likely a result of a systemic cause. Exceptions are reviewed in this article. When allergic contact dermatitis affects only the hands and feet, rubber chemicals and chromates are the most common allergens. Pattern recognition can assist with choice of patch test allergens, counseling regarding routes of exposure, and selection of alternative contactants.