Dyshidrotic dermatitis

Dyshidrotic dermatitis is 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, a short-term course of oral corticosteroids may be are helpful as a temporizing measure.

Other therapeutic options, if symptoms don't respond to initial treatment, include phototherapy, oral immunomodulators, and nickel-directed therapy.

Dyshidrotic dermatitis is a 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, often appearing on the medial and lateral aspects of the fingers and toes.[1]Agner T, Elsner P. Hand eczema: epidemiology, prognosis and prevention. J Eur Acad Dermatol Venereol. 2020 Jan;34 Suppl 1:4-12. https://onlinelibrary.wiley.com/doi/10.1111/jdv.16061 http://www.ncbi.nlm.nih.gov/pubmed/31860734?tool=bestpractice.com ​ 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 some advocate for the term to be reserved for acute, severe eruptions of large bullae on the hands and feet.[2]Fowler JF Jr, Storrs FJ. Nickel allergy and dyshidrotic eczema: are they related? Am J Contact Dermatol. 2001;12:119-121. http://www.ncbi.nlm.nih.gov/pubmed/11381350?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Dyshidrotic eczemaPhotograph courtesy of Dr Spencer Holmes, MD; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Dyshidrotic eczemaPhotograph courtesy of Dr Spencer Holmes, MD; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Dyshidrotic eczemaPhotograph courtesy of Dr Spencer Holmes, MD; used with permission [Citation ends].