I was recently reading a dermatology article that I found quite interesting. The article was discussing “Hot Hand-Foot Syndrome” and showed a picture of a child with bright red palms and soles. It made me stop and read the article, as I am sure I had recently seen a child that looked like that picture. This puzzling syndrome presents with the sudden (acute) onset of warm, tender, red nodules and plaques on the palms and or soles. Most children will also complain of low-grade fever, malaise and tenderness of the palms and soles that may even restrict walking or use of the hands and fingers.

The presentation of this often looks like some sort of viral infection (fever, malaise) with a “weird” rash, but in actuality this is an illness caused by the bacteria Pseudomonas aeruginosa. This bacterium is found in water and soil and can enter the skin through hair follicles, sweat gland ducts, or micro-breaks in the skin. The most common place to be exposed to this bacterium is in hot tubs, saunas or swimming pools. You do not realize that you have even been exposed, but with a good history you may find that the child had been in a hot tub in the last 24