A chronic, relapsing-remitting vesicular eruption of the palms and soles; classically pruritic; also known as dyshidrotic eczema.
The common exacerbating factor is irritation, as seen in frequent hand washing, hyperhidrosis, and stress. However, the underlying etiology 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 characterized 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
- 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 prep
Andrea Bershow, MD
University of Minnesota
AB declares that she has no competing interests.
Dr Andrea Bershow would like to gratefully acknowledge Dr Erin M. Warshaw and Dr Sabra M. Lofgren, previous contributors to this topic. EMW and SML declare that they have no competing interests.
Gina Taylor, MD
Department of Dermatology
SUNY Downstate Medical Center
GT declares that she has no competing interests.
Laura Korb Ferris, MD, PhD
Department of Dermatology
University of Pittsburgh Medical Center
LKF declares that she has no competing interests.
Maria Tsoukas, MD, PhD
Assistant Professor of Medicine
Section of Dermatology
Department of Medicine
University of Chicago
MT declares that she has no competing interests.
Gerard Guillet, MD
Professor of Dermatology
Department of Dermatology and Allergology
University Hospital Poitiers
GG declares that he has no competing interests.
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