Dyshidrotic dermatitis L30.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 07.06.2021

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Synonym(s)

Acute foot eczema; Dermatitis dyshidrotic; Dyshidrosiform dermatitis; Dyshidrosiform eczema; dyshidrotic eczema; Dyshidrotic eczema; Dyshidrotic hand and foot eczema; Eczema dyshidrosiformes

History
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Hutchinson, 1875

Definition
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Polyetiological, usually episodic, acute, subacute or chronically recurrent, vesicular, also vesiculo-squamous dermatitis on palms and soles with clear, about 0.1 cm large, intraepidermally located, greyish shimmering vesicles or (more rarely) also blisters.

If the occurrence of large blisters predominates, the clinical term"pompholyx" is used, on the hands"cheiropompholyx", on the feet "podopompholyx".

If the dyshidrotic dermatitis persists for a longer period of time, there are also coarse-mallar scales and hyperkeratotic plaques. The picture of subacute or chronic hand/foot dermatitis with increasing callosity and painful rhagades then predominates.

In the healing phase of a relapsing vesicular dermatitis, the clinical picture of the so-called dyshidrosis lamellosa sicca with circine raised scales appears.

The clinically visible vesicles of the dyshidrotic eczema are an expression of a spongiotic dermatitis of the groin skin.

Etiopathogenesis
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Occurrence in the context of an atopic diathesis (see below atopy), more rarely also in the case of psoriasis palmoplantaris (see below psoriasis dyshidrotica), allergic contact dermatitis (e.g. nickel allergy), mycosis (vesicular mycosis) or idiopathic if the cause is unknown. Also occurring as a drug reaction (e.g. after IVIG therapy). Dyshidrotic dermatitis occurs preferentially in the warm years.

Localization
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Palmae, Plantae and finger/toe edges. Hands are significantly more frequently and intensively affected than the feet.

Clinical features
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Acute dyshidrotic dermatitis, an acute dermatitis of the hands or feet, is characterized by the eruptive flare-up of minute, usually closely grouped, water-clear, pruritic vesicles on the lateral parts of the fingers and on the palms.

The pattern of infestation on the feet is analogous.

The backs of the hands and fingers as well as the interdigital folds are frequently involved, but show less the picture of the so-called dyshidrosis than that of the classic acute eczema of the field skin with inflammatory papules about 0.1 cm in size, or larger plaques, as well as intact and burst vesicles, possibly also oozing.

If the inflammatory quality of the dermatitic reaction is high (frequently also in the summer months), the vesicles may expand to form large blisters, resulting in the clinical picture of pompholyx.

Complication(s)
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If large-bubble dyshidrotic eczema develops, there is an acute risk of superinfection with acutely occurring painful pustulation, fever, lymphangitis and lymphadenitis.

A so-called gram-negative foot infection can graft itself complicatively on the feet.

General therapy
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Treatment of the underlying disease (e.g. tinea), avoidance of contact allergens, avoidance of extreme temperatures. The dyshidrotic eczema is often seen in smokers. Quitting nicotine is necessary!

External therapy
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In case of non-infectious genesis (e.g. atopic eczema; allergic contact dermatitis) in the acute stage glucocorticoid tinctures such as 0.1% triamcinolone tincture or 0.1% mometasone solution (e.g. Ecural solution) and envelopes with tanning additives such as synthetic tanning agents (e.g. Tannolact, Tannosynt). In case of a collerette-like scaling glucocorticoids in cream base such as 0.1% triamcinolone cream R259, 0.25% prednicarbate cream (e.g. Dermatop), if necessary under occlusion.

Accompanying gentle alkaline-free skin cleansing (e.g. Eucerin, Sebamed), no irritant noxae. Lubricating external agents (e.g. linola grease, ash-based ointment), if necessary with tar-containing additives such as 10% LCD-Creme R153. If necessary, after the acute phase zinc oxide paste with bismuth gallate R289 alternating with oak bark extract baths (see above).

In subacute stages and especially in the presence of hyperhidrosis, tap water iontophoresis has been described as successful.

Radiation therapy
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If the cause is endogenous, therapies with as few side effects as possible should be used, such as local PUVA therapy or UVA-1 cold light therapy.

Internal therapy
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In case of pronounced impetiginization,antibiotic system therapy(antibiotics) with cephalosporins such as cephadroxil (e.g. Cedrox) 1 time/day 1 g p.o. or cephalexin (e.g. Cephalexin-ratiopharm) 1-3 g/day p.o. in 3 ED.

Diet/life habits
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Diet: The connection with oral nickel or chromate intake seen by some authors is controversial. According to the authors, nickel- or chromate-free diets are not promising.

Note(s)
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A historical and misleading term that describes acute or subacute dermatitis of the hands and feet. The term "dyshidrotic" describes the manifestation of spongiotic dermatitis, which is caused by the special anatomical nature of the skin on the palms of the hands and soles of the feet (so-called inguinal skin).

The inguinal skin is characterized by the absence of hair follicles and the formation of a protective, thick horny layer. In a blister-forming dermatitic reaction of the groin skin, the spongiotic blisters remain much longer in the epidermis and are perceived as fine grey dots of barely 0.1 cm in size in the horny layer. In more pronounced eczema reactions, they are also perceived as shiny grey, protruding blisters. The term"dyshidrosis" aims at a defective function of the sweat glands, which is actually not present.

The term "dyshidrosiform", which is supposed to characterise the formation of blisters in atopic hand/foot dermatitis, is equally misleading and thus superfluous.

The term pompholyx(Cheiropompholyx, Podopompholyx) is used to describe the large blistered acute dermatitis of the groin skin.

Literature
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  1. Braun-Falco M et al (2003) Palmoplantar vesicular lesions in childhood. dermatologist 54: 156-159
  2. Grattan Ce et al (1991) Comparison of topical PUVA with UV-A for chronic vesicular eczema. Acta Derm Venerol 71: 18-22
  3. Hutchinson J (1875) Cheiro-Pompholix, dysidrosis. In: Illustrations of clinical surgery. J. Churchill, London
  4. Lee KC et al (2013) Dyshidrotic eczema following intravenous immunoglobulin treatment
    . CMAJ 185:E530
  5. Lehucher-Michel MP et al (2000) Dyshidrotic eczema and occupation: a descriptive study. Contact Dermatitis 43: 200-205
  6. Lodi A et al (1992) Epidemiological, clinical and allergological observations on pompholyx. Contact Dermatitis 26: 17-21
  7. Schubert C Inflammatory skin diseases. An assortment of clinically relevant disease conditions. Pathologist 23: 9-19
  8. Sugimura C et al (2003) Dyshidrosiform pemphigoid: report of a case. J Dermatol 30: 525-529
  9. Swartling C et al (2002) Treatment of dyshidrotic hand dermatitis with intradermal botulinum toxin. J Am Acad Dermatol 47: 667-671
  10. Yokozeki H et al (1992) The role of metal allergy and local hyperhidrosis in the pathogenesis of pompholyx. J Dermatol 19: 964-967
  11. Yoon SY et al (2012) Histological differentiation between palmoplantar pustulosis and pompholyx. J Eur Acad Dermatol Venereol 27:889-893

Disclaimer

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

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Last updated on: 07.06.2021