dyshidrotic eczematous dermatitis; pompholyx

Introduction

A vesicular hand & foot dermatitis. Despite the name (dyshidrotic), there are no associated abnormalities of sweat glands.

Etiology

• frequent wetting & drying, sweating
• allergies, reaction to Tinea
• typically observed in patients with a history of atopic dermatitis
• emotional stress may be a precipitating factor

Epidemiology

• ages 12-40 years
• no sex predilection
• often appear with the summer heat
• case report of 22 year old woman who recently started a job as a dishwasher

Pathology

• NO dysfunction of sweat glands
• eczematous inflammation
  • spongiosis & intraepidermal edema
• intraepidermal vesicles

Clinical manifestations

• acute vesicular eruption on the palms & soles
  • initially, lateral aspects of fingers, palms & soles
  • later, dorsa of fingers
    • small, itchy blisters during summer heat
• abrupt appearance of clear, pruritic vesicles
• later papules, scaling, fissures & lichenification
• erosions may result from coalescence of ruptured vesicles
• outbreaks generally last for several weeks
• pruritus at sites of new vesicles
• pain in fissures & secondarily infected lesions
• lesions spread peripherally, but have a tendency to clear centrally

*images

Laboratory

• bacterial culture, rule-out Staphylococcus aureus
• KOH preparation, rule-out dermatophytosis
• skin biopsy

Complications

• secondary infection
  • Staphylococcus aureus (most common)
  • group A streptococcus

Differential diagnosis

• contact (allergic or irritant) dermatitis
• atopic dermatitis
• bullous tinea pedis 'id reaction'
• scabies

Management

• generally difficult to treat
• emollients (petrolatum)
• avoid corticosteroids except in rare, short-term flare-ups
  • high-potency topical steroids with plastic occlusive dressings for 1-2 weeks
  • intralesional triamcinolone injection 3 mg/mL
  • prednisone taper: state 70 mg PO QD; taper over 1-2 weeks
• wet dressing for early vesicular stage
• large bullae should be drained with a puncture wound, but NOT unroofed
• systemic antibiotics for secondary bacterial infection
• PUVA, oral or topical as soaks for severe cases
• white cottom glove liners inside rubber gloves
• spontaneous remissions in 2-3 weeks

More general terms

• vesiculobullous dermatitis