Dyshidrotic eczema

Last Updated: 2022-03-25

Author(s): Anzengruber, Navarini

ICD11: EA85.0

Hutchinson, 1875.

Dyshidrosis, dyshidrotic eczema, dyshidrotic hand eczema, dyshidrotic hand and foot eczema, dyshidrotic foot eczema, dyshidrotic hand eczema, dyshidrotic hand and foot eczema,

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Intraepidermal vesiculosis and bullous variant of hand eczema

  • Occurrence mostly in the young middle aged persons.
  • Higher prevalence in warm, humid climates (summer).
  • Idiopathic.
  • Atopic diathesis (very often).
  • Contact allergy (often nickel or cobalt).
  • Hyperergic reaction (Id reaction) in mycosis.
  • Hyperhidrosis (some authors deny the association, the majority do not).
  • Psychogenic as a result of stress reactions.
  • Tobacco abuse is associated with exacerbation.
  • Administration of intravenous immunoglobulins.
  • UV exposure (case series with 5 patients, but light therapy is used as therapy).
  • Pruriginous, often symmetrically arranged, pin-sized, eruptive, grouped, water-clear, pruriginous vesicles and bullae palmoplantar, in particular it can come to an intensified occurrence at the finger edges.
  • The backs of the hands and fingers show erythematous, pruritic, sometimes disseminated papules and vesicles
  • When there are pronounced blisters on the edges of the fingers, this is referred to as a pompholyx.
  • Often patients describe ↑ tendency to sweat.
  • Variants of dyshidrosis:
    • Cheiropompholyx and podopompholyx: maximum variant
    • Dyshidrosis lamellosa sicca (exfoliatio manuum areata): The vesicles dry up quickly, resulting in a ruff-like scaling.
  • Anamnesis with regard to aetiologically significant factors (atopy, contact allergies, hyperhidrosis, psychological stressors)
  • Mycology, if suspicion exists.
  • Epicutaneous testing, if contact allergy is suspected.
  • Atopy screening (total IgE).

Palmoplantar. Predilection sites are the interdigital spaces (transition between groin skin and field skin).

The picture is one of acute allergic contact dermatitis with spongiotic blistering, acrosyringia, perivascular, lymphocytic infiltrates in the stratum papillare stratum reticulare.

  • Superinfection.
  • Gram-negative forefoot infection.

Frequent recurrences.

  • Therapy of the underlying disease, if present and possible.
  • Elevation of the affected extremities.
  • Nicotine abstinence.
  • Avoidance of identified contact allergens
  • A psychiatric consultation may be discussed if psychogenic triggers are suspected. We advise against the use of psychotropic drugs (e.g.: opipramol, or sedatives) without consulting a psychologist or psychiatrist
  • It is uncertain whether a nickel- or chromium-free diet is effective, even with proven contact sensitisation to it.

Skin care:

  • For hyperhidrosis: aluminium chlorohydrate daily
  • Remoisturing 

Steroids

  • Mometasone fuorate cream
  • for impetiginisation betamethasone and fusidic acid cream

Tomentary baths:

  • Black tea hand baths 

Moist dressings with sodium chloride solutions at ↑ eruption pressure

In case of hyperhidrosis

  • Liquid iontophoresis

UV therapy

  • PUVA therapy.

Systemic therapy

  • If acutely necessary: Prednisolone (Spiricort®) p.o. 40-60 mg once daily
  1. Veien NK, Hattel T, Justesen O, Norholm A. Oral challenge with metal salts. (I). Vesicular patch-test-negative hand eczema. Contact Dermatitis 1983;9:402-6.
  2. Guillet MH, Wierzbicka E, Guillet S, Dagregorio G, Guillet G. A 3-year causative study of pompholyx in 120 patients. Arch Dermatol 2007;143:1504-8.
  3. Lehucher-Michel MP, Koeppel MC, Lanteaume A, Sayag J. Dyshidrotic eczema and occupation: a descriptive study. Contact Dermatitis 2000;43:200-5.
  4. Uyttendaele H, Obadiah J, Grossman M. Dyshidrotic-like spongiotic dermatitis after intravenous immunoglobulin therapy. J Drugs Dermatol 2003;2:337-41.
  5. Iannaccone S, Sferrazza B, Quattrini A, Smirne S, Ferini-Strambi L. Pompholyx (vesicular eczema) after i.v. immunoglobulin therapy for neurologic disease. Neurology 1999;53:1154-5.
  6. Gerstenblith MR, Antony AK, Junkins-Hopkins JM, Abuav R. Pompholyx and eczematous reactions associated with intravenous immunoglobulin therapy. J Am Acad Dermatol 2012;66:312-6.
  7. Shiraishi T, Yamamoto T. Severe dyshidrotic eczema after intravenous immunoglobulin therapy for Kawasaki syndrome. Pediatr Dermatol 2013;30:e30-1.
  8. Douwes KE, Karrer S, Abels C, Landthaler M, Szeimies RM. Does smoking influence the efficacy of bath-PUVA therapy in chronic palmoplantar eczema? Photodermatol Photoimmunol Photomed 2000;16:25-9.
  9. Man I, Ibbotson SH, Ferguson J. Photoinduced pompholyx: a report of 5 cases. J Am Acad Dermatol 2004;50:55-60.
  10. Adams, D. (2016). Acute palmoplantar eczema (dyshidrotic eczema). Uptodate.com. Retrieved 31 May 2016, from http://www.uptodate.com/contents/acute-palmoplantar-eczema-dyshidrotic-eczema?source=search_result&search=dyshidrosiformes+ekzem&selectedTitle=1~18