Dyshidrosis L30.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Dyshidrosis; Dyshidrosis Syndrome; Pompholyx

History
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Fox, 1873

Definition
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A clinical picture of varying aetiology associated with clear, intraepidermal vesicles on the palms of the hands and soles of the feet, often associated with hyperhidrosis. The clinically visible vesicles are the expression of an underlying spongiotic dermatitis in the area of the groin skin. S.a. Eczema dyshidrotic.

Etiopathogenesis
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Polyetiological clinical picture often associated with Hyperhidrosis manuum (pedum). The increased occurrence in summer and an increased prevalence in warm and humid climates underlines the relationship to an increased sweat gland function.

Idiopathic: often a cause cannot be identified!

Dyshidrosis as Id reaction: can occur as a mycid in acute exacerbation of a tinea pedis or corporis.

Contact allergy: often occurs at the base of dyshidrosis. In the case of contact allergy caused by insoles, this is the only trigger of dyshidrosis.

Minimal variant of atopic dermatitis, possibly also in the context of an acute episode of psoriasis palmaris et plantaris.

Localization
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Side edges of fingers (especially in atopic diathesis), palms of hands, soles of feet.

Clinical features
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Clear, intraepidermally located, small, rough, 0.1 cm to 0.2-0.3 cm large, differently itchy blisters. Drying out and formation of a ruffle-like scaling or bursting and formation of erosions. In the end, the only residuals that often impress are circine scaling.

Frequently, vesicles are not perceived or they do not appear clinically, so that the clinical picture only appears as a recurrent scaling scenario with dry, ruffled scaling(Dyshidrosis lamellosa sicca).

A maximum variant of dyshidrosis or dyshidrotic eczema with large blisters is called pompholyx(cheiropompholyx/hand infestation or podopompholyx/foot infestation).

Histology
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Spongiotic blistering.

Diagnosis
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Mycology, epicutaneous, prick test, IgE.

Differential diagnosis
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General therapy
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Treatment of the underlying disease, avoidance of contact allergens, treatment of tinea, avoidance of extreme temperatures, eczema, dyshidrotic.

External therapy
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For initial changes as well as as a prophylactic measure, local baths with astringent additives such as synthetic tanning agents (e.g. Tannolact, Tannosynt). In case of non-infectious genesis (e.g. atopic eczema, allergic contact dermatitis) in the acute stage glucocorticoid tinctures such as 0.1% triamcinolone acetonide tincture(e.g. Triamgalen Lsg. or 0.1% mometasone solution (e.g. Ecural) and envelopes with tanning additives such as oak bark extract or synthetic tanning agents (e.g. Tannosynt, Tannolact). If necessary, after the acute phase zinc oxide paste with bismuth gallate R289 alternates with the baths containing tanning agents. In subacute stages and especially in the presence of hyperhidrosis, tap water iontophoresis can be attempted. In case of a collerette-like desquamation glucocorticoids in cream base like 0.1% triamcinolone acetonide cream(e.g. Delphicort, R259 ) or 0.25% prednicarbate cream(e.g. Dermatop) can be applied, if necessary under occlusion.

Internal therapy
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In the case of pronounced impetiginisation, antibiotic systemic therapy with cephalosporins such as cefadroxil (e.g. Cedrox) once/day 1 g p.o. or cefalexin (e.g. cephalexin-ratiopharm) once/day 1 g p.o.

Note(s)
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Dyshidrosis is a historical and unfortunately misunderstood term that describes acute or subacute dermatitis of the hands and feet. The term "dyshidrotic" refers to a "manifestation of eczema" which is caused by the special anatomical nature of the skin on the palms of the hands and soles of the feet (so-called groin skin). The groin skin is characterized by the absence of hair follicles and the formation of a protective, thick horny layer. In a blistering eczema reaction, the spongiotic blisters remain much longer in the skin and are perceived as fine grey dots in the horny layer, barely 0.1 cm in size. The term"dyshidrosis" is aimed at a defective sweat gland function, which in fact was not originally present. The term "dyshidrosiform", which is supposed to describe the formation of blisters in atopic hand and foot eczema, is equally misleading and superfluous.

Literature
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  1. Man I et al (2004) Photoinduced pompholyx: A report of 5 cases. J Am Acad Dermatol 50: 55-60
  2. Fox T (1873) Skin diseases. 3rd ed. H. Renshaw, London, p. 476

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020