A chronic, relapsing-remitting vesicular eruption of the palms and soles; classically pruritic; also known as dyshidrotic eczema dermatitis.
The common exacerbating factor is irritation, as seen in frequent hand washing, hyperhidrosis, and stress. However, the underlying aetiology is unknown.
Diagnosis is based on characteristic history and physical examination.
The foremost objective in treatment is identification and avoidance of exacerbating factors.
First-line therapy is topical corticosteroids or immunomodulators.
For severe eruptive bullae on the palms and soles, which are consistent with pompholyx, oral corticosteroids are helpful.
Other therapeutic options, if symptoms don't respond to initial treatment, include phototherapy, oral immunomodulators, and nickel-directed therapy.
Dyshidrotic dermatitis is a relatively common form of chronic dermatitis affecting the hands and feet. It is characterised by recurrent crops of 1- to 2-mm vesicles on the palms, soles, and lateral aspects of the fingers. Crops persist for 2 to 3 weeks and return at variable intervals. Pruritus accompanies the eruptions and may even precede them. Pompholyx is a term often used synonymously with dyshidrotic dermatitis, but it is better used to describe more acute, severe eruptions of large bullae on the hands and feet.
History and exam
Key diagnostic factors
- presence of risk factors
- skin lesions
Other diagnostic factors
- recurrent eruptions
- exposure to irritants
- metal allergy
- emotional stress
1st investigations to order
- clinical diagnosis
Investigations to consider
- skin biopsy
- potassium hydroxide (KOH)
- patch testing
- scabies preparation
- Tinea manuum/pedis
- Palmoplantar psoriasis
- Allergic contact dermatitis
- Guidelines for diagnosis, prevention and treatment of hand eczema
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